Small in size, big in scope: Point of care testing in rural and remote Queensland

As you may have noticed Australia is a very big country. The tyranny of distance and its corresponding poor access to health services for people living in rural and remote communities is one of the biggest issues facing Australian medicine.

A 2014 report from the Australian Institute of Health Welfare estimated that a third of Australians live outside the major cities and noted that mortality rates and rates of preventable hospitalisations increase with remoteness.

Luckily, Australian pathology is committed to making testing readily accessible to all patients through point of care testing – medical tests near the patient.

A major benefit of point of care testing (POCT) is improving access to testing in rural and remote healthcare.

POCT provides immediate access to test results that might otherwise have been hours or even days away for samples to be transported to a lab. This immediacy to medical indications allows patients who may have previously been “medevaced” (transported to receive urgent medical attention) to receive local care. This can avoid the distress of relocation and it reduces patient drop-off by generating instant results especially helpful in the management of chronic conditions.

A/Prof Bruce Chater, Head of Rural and Remote Medicine at University of Queensland, is very clear on the huge impact point of care testing has had on this area of medicine;

“Bedside pathology and other technologies are revolutionising rural practice. The ability to diagnose a heart attack, monitor medication, check salts and kidney function and check the blood gases in a seriously ill patient means that rural generalists can make more informed decisions when they need to be made – here and now.”

One example is the use of the i-STAT in Queensland. This handheld blood analyser uses single use test cartridges, meaning the device can be used for a broad range of the most commonly performed tests including cardiac markers, coagulation, blood gases, chemistries and electrolytes, and haematology.

The Pathology Queensland i-STAT network is the largest in geographical size in the world – the network covers the entire state from the Sabai islands in the north to Stanthorpe in the south. Within minutes of a sample being taken the results are available on the state-wide database.

To ensure results are accurate equipment is tested daily and all staff receive comprehensive training. Results are reviewed by medical scientists and unexpected results are followed up further. The network also takes part in the quality program run by the Royal College of Pathologists of Australasia.

The entire network is managed centrally from Brisbane, meaning that even the most geographically isolated of health clinics are fully supported.

Amongst Aboriginal and Islander patients in Cape York and the Torres Strait, rheumatic heart disease is a significant health problem. Treatment requires anticoagulant medication that must be closely monitored. Before the introduction of the i-STAT, samples for monitoring would have to be sent from outlying islands to Cairns. In summer, samples did not always survive the trip but point of care testing has overcome this problem.

Last year the Pathology Queensland i-STAT network performed over a quarter of a million patient episodes. Access to pathology services for all Australians, wherever they live, is just one of the many reasons why Australian pathology is world-class.