Abstract
Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.
Highlights
Primary health care describes the first contact an individual with a health concern has with the health system that is not related to a hospital visit
Due to the high proportion of Aboriginal and Torres Strait Islander people living in remote Australia, health services in these regions are provided by either: (i) Aboriginal Community Controlled Health Services (ACCHOS), which are funded by the Australian Government and administered by a Board comprising Aboriginal and Torres Strait Islander representatives from the respective community or (ii) State or Territory funded health services [7]
With the burden of acute, chronic, and infectious diseases amongst Aboriginal and Torres Strait Islander people higher than that of the non-Indigenous population and the highest Indigenous disease rates correlating with degree of geographic remoteness [3], the overarching Indigenous governance of ACCHOs assists in the delivery of culturally safe health services to address health inequity in Australia [7]
Summary
Primary health care describes the first contact an individual with a health concern has with the health system that is not related to a hospital visit. The workforce of Australian rural and remote primary health care relies more on general practitioners (GPs) to provide health care services, either on-site, or more recently via telehealth consultations [4, 5]. With the burden of acute, chronic, and infectious diseases amongst Aboriginal and Torres Strait Islander people higher than that of the non-Indigenous population and the highest Indigenous disease rates correlating with degree of geographic remoteness [3], the overarching Indigenous governance of ACCHOs assists in the delivery of culturally safe health services to address health inequity in Australia [7]. POC testing has proven to be a transformative and life-changing technology for health services and patients in remote Australian communities. POC test results allow the health practitioner to make immediate and informed decisions for patient management, including the rapid initiation of treatment and/or alternative health intervention strategies.
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