Spaeth Brooke A, Shephard Mark D S, Schatz Steven
Level 3 West Wing, Sturt Campus, Flinders University, Bedford Park, South Australia, 5042, Australia..
Unit 2C, Casuarina Plaza Casuarina, Darwin, Northern Territory 0811, Australia..
Rural Remote Health. 2014;14(4):2849. Epub 2014 Oct 30.
In remote Australia timely access to pathology results and subsequent follow-up of patients for treatment is very challenging due to the long distances to the nearest laboratory. Point-of-care testing (POCT) offers a practical solution for pathology service provision in such remote communities. Since 2008, POCT for haemoglobin A1c (HbA1c) has been conducted in remote Northern Territory (NT) health centres for diabetes management of Indigenous patients through the national Quality Assurance in Aboriginal and Torres Strait Island Medical Services (QAAMS) Program.
Point-of-care testing HbA1c results performed on Indigenous diabetes patients in the NT from July 2008 to April 2011 was accessed via the NT's electronic patient information system. Patients who had three or more HbA1c results performed by POCT across this period were assessed to determine their overall change in glycaemic control. An audit of 40 of these Indigenous diabetes patients (who exhibited a decrease in HbA1c levels of more than 1.5%) was undertaken to compare clinical and operational efficiency of POCT versus laboratory testing over an equivalent time period (15 months).
No change in glycaemic control was observed when these patients received laboratory HbA1c testing prior to the introduction of POCT. Long turnaround times for receipt of results and follow-up consultation with patients were identified during this period, compared to immediate receipt and actioning of results using POCT. Frequency of HbA1c testing was higher with POCT than for the laboratory.
This audit demonstrates that POCT can significantly improve the timeliness and clinical follow-up of pathology results in remote locations, while also reinforcing the clinical and cultural effectiveness of POCT and its critical role in assisting to improve diabetes management in Indigenous Australians.
在澳大利亚偏远地区，由于距离最近的实验室路途遥远，及时获取病理检查结果并对患者进行后续治疗随访极具挑战性。即时检验（POCT）为在这些偏远社区提供病理服务提供了切实可行的解决方案。自2008年以来，通过国家原住民和托雷斯海峡岛民医疗服务质量保证（QAAMS）项目，在北领地（NT）偏远地区的医疗中心开展了糖化血红蛋白（HbA1c）即时检验，用于原住民患者的糖尿病管理。
通过北领地的电子患者信息系统获取2008年7月至2011年4月期间在北领地对原住民糖尿病患者进行的即时检验HbA1c结果。对在此期间有三次或更多次即时检验HbA1c结果的患者进行评估，以确定其血糖控制的总体变化。对其中40名原住民糖尿病患者（其HbA1c水平下降超过1.5%）进行了审核，以比较即时检验与实验室检测在相同时间段（15个月）内的临床和操作效率。
在引入即时检验之前，这些患者接受实验室HbA1c检测时，未观察到血糖控制有变化。在此期间，发现接收结果和与患者进行随访咨询的周转时间较长，而使用即时检验可立即接收结果并采取行动。即时检验的HbA1c检测频率高于实验室检测。
本次审核表明，即时检验可显著提高偏远地区病理检查结果的及时性和临床随访，同时也强化了即时检验的临床和文化有效性及其在协助改善澳大利亚原住民糖尿病管理中的关键作用。
