Point-of-Care Testing Collected Works

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    Economic evaluation of point-of-care testing in the remote primary health care setting of Australia’s Northern Territory
    (Dove Press, 2018-05-29) Spaeth, Brooke; Kaambwa, Billingsley; Shephard, Mark Douglas; Omond, Rodney
    Aim: To determine the cost-effectiveness of utilizing point-of-care testing (POCT) on the Abbott i-STAT device as a support tool to aid decisions regarding the emergency medical retrievals of patients at remote health centers in the Northern Territory (NT) of Australia. Methods: A decision analytic simulation model–based economic evaluation was conducted using data from patients presenting with three common acute conditions (chest pain, chronic renal failure due to missed dialysis session(s), and acute diarrhea) at six remote NT health centers from July to December 2015. The specific outcomes measured in this study were the number of unnecessary emergency medical retrieval prevented through POCT. Cost savings through prevented unnecessary medical retrievals for each presentation type were then determined and extrapolated to give per annum NT-wide estimates. Results: POCT prevented 60 unnecessary medical evacuations from a total of 200 patient cases meeting the selection criteria (48/147 for chest pain, 10/28 for missed dialysis, and 2/25 for acute diarrhea). The associated cost savings were AUD $4,674, $8,034, and $786 per patient translating to NT-wide savings of AUD $13.72 million, $6.45 million, and $1.57 million per annum (AUD $21.75 million in total) for chest pain, missed dialysis, and acute diarrhea presentations, respectively. Conclusion: This study demonstrated that POCT when used to aid decision making for acutely ill patients delivered significant cost savings for the NT health care system by preventing unnecessary emergency medical retrievals.
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    How to set up and manage a point-of-care testing service
    (Australasian Association of Clinical Biochemists, 2004) Shephard, Mark Douglas
    In this paper, various point-of-care testing (POCT) models for early detection and/or management of chronic diseases in rural Aboriginal communities are used to provide practical examples of how to set up and manage a viable and sustainable point-of-care testing (POCT) service, whether it be in a general medical practice (GP) clinic, Aboriginal health service, or hospital service or clinic.
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    Point-of-care testing in the Indigenous rural community
    (Australasian Association of Clinical Biochemists, 2004) Shephard, Mark Douglas
    This paper describes three health programs - the 'Umoona Kidney Project', the national 'QAAMS' Program for point-of-care HbA1c testing and the 'Point-of-Care in Aboriginal Hands' Program. The common feature these models share is the use of point-of-care technology for the early detection and/or management of chronic diseases (renal disease, diabetes and cardiovascular disease). The primary focus of each program has been the rural and remote Aboriginal Community Controlled Health Service (ACCHS) sector, because these three chronic diseases account for a huge burden of morbidity and mortality in Aboriginal Australians.
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    The national QAAMS Program - a practical example of PoCT working in the community
    (Australasian Association of Clinical Biochemists, 2010) Shephard, Mark Douglas; Gill, Janice P
    The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) Program is the largest and longest-standing national point-of-care testing (PoCT) program in Australia. With a focus on PoCT for diabetes management, it now operates in 115 Indigenous medical services and has been funded continuously by the Australian Government for 11 years. A recent independent evaluation of the QAAMS Program concluded the program continues to meet best practice standards for Indigenous healthcare, diabetes management and PoCT.
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    The conduct of quality control and quality assurance testing for PoCT outside the laboratory
    (Australasian Association of Clinical Biochemists, 2010) Gill, Janice P; Shephard, Mark Douglas
    Within pathology laboratories, quality assessment, internal quality control (QC) and external quality assurance (EQA) are integral components of a laboratory’s quality system. They are tools to ensure that the quality of results being produced by laboratory testing will not compromise the clinical care of the patient. This criterion applies equally when the testing environment changes from the laboratory to the point of care, and the large laboratory instrument becomes a smaller device.
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    Point-of-care testing and creatinine measurement
    (Australasian Association of Clinical Biochemists, 2011) Shephard, Mark Douglas
    This paper reviews the current status of point-of-care testing (PoCT) devices that are available for measuring whole blood or serum/plasma creatinine globally and within Australasia. Information on non-analytical specifications and analytical performance is provided using data sourced from recently published literature, external quality assurance programs and evaluative work by the author’s unit. The limitations of current devices are summarised.
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    Evaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices
    (Australian Rural Health Education Network, 2009) Shephard, Mark Douglas; Mazzachi, Beryl C; Watkinson, Les; Shephard, Anne Kathryn; Laurence, Caroline O; Gialamas, Angela; Bubner, Tanya
    From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program.
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    Assessment of the Nova StatSensor whole blood point-of-care creatinine analyser for the measurement of kidney function in screening for chronic kidney disease
    (Walter de Gruyter, 2010) Shephard, Mark Douglas; Peake, Michael; Corso, Olivia; Shephard, Anne Kathryn; Mazzachi, Beryl C; Spaeth, Brooke; Barbara, Jeffrey A J; Mathew, Timothy
    Point-of-care testing for creatinine using a fingerprick sample and resultant estimated glomerular filtration rate has potential for screening for chronic kidney disease in community settings. This study assessed the applicability of the Nova StatSensor creatinine analyzer for this purpose. Fingerprick samples from 100 patients (63 renal, 37 healthy volunteers; range 46–962 mmol/L) were assayed using two StatSensor analyzers. Lithium heparin venous plasma samples collected simultaneously were assayed in duplicate using the isotope dilution mass spectrometryaligned Roche Creatinine Plus enzymatic assay on a Hitachi Modular P unit. Method comparison statistics and the ability of the StatSensor to correctly categorise estimated glomerular filtration rate above or below 60 mL/min were calculated pre- and post-alignment with the laboratory method. Isotope dilution mass spectrometry alignment of the StatSensor will identify most patients with estimated glomerular filtration rate -60 mL/min, but there will be many falsely low estimated glomerular filtration rate results that require laboratory validation. Creatinine results need improvement.
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    Point-of-care testing comes of age in Australia
    (NPS MedicineWise, 2010) Shephard, Mark Douglas
    A wide range of point-of-care tests is available and being used in both hospital and community settings for acute and chronic illnesses. There have been significant improvements in device technology as well as advances in training methods, procedures to monitor analytical quality, and the electronic capture and management of test results from a central location. Various point-of-care tests have been found to be not inferior to laboratory testing for managing chronic conditions in general practice and Aboriginal medical services. Maintaining the analytical quality of devices and ensuring that staff are properly trained are critical elements in sustaining a high quality point-of-care testing service.
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    The Umoona Kidney Project
    (Aboriginal and Islander Health Worker Journal, 2000) Shephard, Mark Douglas; Brown, Michael A; Hudson, Maryanne; Riessen, Cissie; Braun, Janice
    Kidney disease is one of the most serious problems facing Aboriginal Australians. Nationally the number of Aboriginal people with advanced or end-stage kidney disease is six times that of non-Aboriginal Australians. It has recently been predicted that a further 500 Aboriginal people will develop end-stage kidney disease by the year 2004. The only treatment options for Aboriginal people with advanced stage kidney disease are dialysis or transplantation, both of which cause significant social and cultural trauma for the individual and their family. Early detection of renal disease is critical because, if identified early enough, progression to end-stage kidney disease can be slowed or even prevented. As a result, early detection has the potential to significantly reduce the number of Aboriginal people who may ultimately require dialysis or transplantation.
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    Point-of-care in Aboriginal hands
    (Aboriginal and Islander Health Worker Journal, 2002) Jones, Richard; Mazzachi, Beryl C; Shephard, Mark Douglas
    Diabetes, kidney disease and heart disease (all chronic diseases) are among the most serious health problems facing Aboriginal people today. The point-of-care program has a broad chronic disease focus that (a) looks for early signs of diabetes, kidney disease and heart disease collectively and (b) provides follow-up management for people identified as being at risk for chronic disease.
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    Assisting diabetes management through point-of-care HbA1c testing - the QAAMS program for Aboriginal health workers
    (Aboriginal and Islander Health Worker Journal, 2003) Shephard, Mark Douglas; Mundraby, Kay
    Diabetes has had a devastating impact on the health of Indigenous people throughout the world. In Australia, Aboriginal and Torres Strait Islander people suffer between 12 and 17 times more deaths due to diabetes than non-Indigenous people. In many Aboriginal communities rates of Type 2 diabetes range from 15% to 30%. Diabetes itself is a significant risk factor for heart disease and is the major cause of end-stage renal disease in Aboriginal people. This article describes a national program called QAAMS (or Quality Assurance for Aboriginal Medical Services) that was developed to assist the management of Aboriginal people with diabetes. Aboriginal Health Workers administer the program on a day-to-day basis. The unique feature of the program is that it uses a point-of-care medical instrument (called the DCA 2000) to measure a test for the long-term control of diabetes (called Haemoglobin A1c).
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    Measuring change
    (Australian Doctor online, 2011) Barker, George; Shephard, Mark Douglas; Goodall, Ian; Obersteller, Elizabeth; Jones, Graham
    A change in the reporting of HbA1c is being adopted globally, including in Australia. It's anticipated that this change will, among other things, make it easier for doctors to educate their patients about the importance of glycaemic control. However, to understand how this change will help in practice, it's useful to firstly understand what HbA1c is and to know something of the history of how laboratories have measured the HbA1c assay.
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    Screening for renal disease in a remote Aboriginal community using the Bayer DCA 2000
    (Australian Institute of Medical Scientists, 2001) Shephard, Mark Douglas; Allen, G G
    End-stage renal disease among Aboriginal Australians has reached alarming proportions during the past decade. The early identification of this disease through community screening programs is a key strategy in reducing the long-term financial and cultural burden of the disease. The small point-of-care Bayer DCA 2000 analyser, which tests for urine albumin:creatinine ratio (ACR), was used as a marker for early renal disease in an adult screening program in a remote South Australian Aboriginal community. Nineteen percent of 149 adults screened had previously undiagnosed persistent microalbuminuria (ACR between 3.4 and 33.9 mg/mmol), while a further 9% had persistent overt albuminuria (ACR greater than or equal to 34 mg/mmol). Aboriginal health workers were trained in the operation of the DCA 2000 to enable screening to be an ongoing, sustainable activity within the community setting. The DCA exhibited excellent analytical performance characteristics and was robust and reliable throughout the study period.
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    Assessment of the point-of-care Cholestech Lipid Analyser for lipid screening in Aboriginal communities
    (Australian Institute of Medical Scientists, 2002) Shephard, Mark Douglas; Tallis, George A
    Cardiovascular disease is the leading cause of mortality in Aboriginal Australians. Screening for cardiovascular disease risk factors, notably elevated blood lipids, is urgently needed. The small portable Cholestech machine (Point-of-Care Diagnostics) can enzymatically measure total cholesterol, triglyceride and HDL cholesterol (without the prior need for precipitation of other lipoproteins)on 35 microlitres of capillary or veinous whole blood in under 5 minutes. It also calculates LDL cholesterol. Its suitability for use in Aboriginal communities was assessed. With its simple operation, fully automated nature, sound analytic performance and ability to produce a full lipid profile in under 5 minutes, the Cholestech would be suitable for the Aboriginal health care setting.
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    Point-of-care testing in the Aboriginal community
    (Australian Institute of Medical Scientists, 2003) Shephard, Mark Douglas
    This article documents experiences working in the field of Aboriginal health. The principle focus of the work is the application of Point-of-Care (POC) technology for the early detection and management of chronic diseases in the Aboriginal community setting. Apart from the well acknowledged advantages of using POC technology such as portability and small sample size, there are other advantages specific, and directly applicable, to the Aboriginal health care setting.
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    Albuminuria in a remote South Australian Aboriginal community: results of a community based screening program for renal disease
    (2003) Vanajek, Anne; Paizis, K; Allen, G G; Shephard, Mark Douglas; Barbara, Jeffrey A J; Barratt, L J; Brown, Michael A; McLeod, G
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    The impact of point of care testing on diabetes services along Victoria's Mallee Track. Results of a community-based diabetes risk assessment and management program
    (2005) McLaughlin, Kristin Jane; Denner, B; Barnes, G; Shephard, Anne Kathryn; Shephard, Mark Douglas; Mazzachi, Beryl C
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    Results of an Aboriginal community-based renal disease management program incorporating point of care testing for urine albumin: creatinine ratio
    (2006) Shephard, Mark Douglas; Allen, G G; Paizis, K; Barbara, Jeffrey A J; Batterham, M J; Vanajek, Anne
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    An Aboriginal-driven program to prevent, control and manage nutrition-related 'lifestyle' diseases including diabetes
    (2006) Gracey, Michael; Bridge, Ernie; Martin, David; Jones, Timothy; Spargo, Randolph M; Shephard, Mark Douglas; Davis, Elizabeth A