Point-of-Care Testing in Aboriginal Hands-A Model for Chronic Disease Prevention and Management in Indigenous Australia

摘要

Point-of-care testing (POCT) has a critical niche in rural and remote indigenous Australia where geographic isolation from laboratory services is common, the resultant turnaround of laboratory results is often slow, and the burden of chronic disease is very high. This paper describes a POCT program called Point-of-Care in Aboriginal Hands, which delivers POCT services for chronic disease prevention and management to 4 rural and remote Aboriginal medical services in Australia. Aboriginal health workers were trained as POCT operators of the DCA 2000 (Bayer Diagnostics, Tarrytown, NY) and the Cholestech LDX lipid analyzer (Cholestech, Hayward, Calif). Prevalence rates in the general community for diabetes (17%), microalbuminuria (20%), and obesity (48%) were between 2 to 3 times the national average. Statistically significant reductions in hemoglobin A1c (HbA1c) of 0.7% and 1.2% (paired t test, P < 0.05) in type 2 diabetes patients (n = 45 and 24) after the introduction of POCT at 2 services confirmed that POCT had been an effective tool in improving clinical outcomes. Community acceptance of POCT was extremely high among key stakeholder groups (doctors, Aboriginal POCT operators and diabetes patients) interviewed and surveyed in the program. The percentage of patients who were satisfied with their diabetes service after the introduction of POCT rose significantly from 64% to 88%, whereas the percentage unsatisfied or unsure about their diabetes service fell from 8% to 3% and 28% to 9% after POCT (Fisher exact test, chi~2_7 = 9.7; P = 0.03). The POCT proved versatile and adaptable in the varied mix of participating communities, which came from widely divergent geographical locations.