Point-of-care testing for better management of acutely ill remote patients.

Can point-of-care testing lead to improved medical support for acutely ill patients living in rural and remote Australia and provide cost savings for the health system?

Grant ID: EMF R&R R120

Project Summary

Australians living in rural and remote areas experience a significantly higher burden of acute care episodes compared to those living in metropolitan and urban areas. A contributing factor is the effect of geographical isolation and its impact on access to health services including pathology testing. We aim to assess the benefits of using point-of-care testing at remotely located health centres of the Northern Territory. Point-of-care testing enables pathology testing to be performed on-site, with results available during the patient consultation. We will investigate the clinical benefits of using point-of-care testing to either rule-out a potential acute medical problem, stabilise an acutely ill patient, and/or to confirm an emergency medical evacuation is required for patient care. The project will also determine the cost savings associated with point-of-care testing preventing unnecessary emergency medical retrievals, which come at a high cost to the Northern Territory Government.

Outcomes

The research team found that POCT enabled more informed triaging of acutely ill patients requiring evacuation to a tertiary hospital as well as ruling out the need for evacuation for patients who could remain in the community and be stabilised safely using POCT. In this study, POCT prevented 60 unnecessary medical evacuations. These findings translated to NT-wide savings of AUD $21.75 million in total per annum for chest pain, missed dialysis, and acute diarrhea presentations.

The study involved, 200 patient cases. Of the 147 patients with chest pain, 126 patients were not evacuated due to on-site POCT for troponin I; from this latter group, 48 patients (38%) would have been evacuated if POCT was not available. Of 28 patients who missed dialysis sessions, 17 were evacuated, Three of seven patients (43%) identified with non-STEMI through POCT would not have been evacuated if POCT was unavailable. Of 17 patients evacuated with acute renal disease, four (24%) had initial potassium results >6.5 mmol/L; all four received calcium gluconate/resonium medication and serial POCT with decreased potassium levels at evacuation. All 10 patients evacuated with acute diarrhoea received rehydration therapy prior to evacuation.

Dissemination

- Spaeth B.A., Kaambwa B., Shephard D.S., Omond R., “Economic evaluation of point-of-care testing in the remote primary health care setting of Australia’s Northern Territory”, ClinicoEconomics and Outcomes Research, 2018; 10: 269–277. doi.org/10.2147/CEOR.S160291

- Spaeth B.A., Shephard M.D.S., Omond R., 'Clinical Application of Point-of-Care Testing in the Remote Primary Health Care Setting', "Quality in Primary Care", 2017; 25(3): 164-175