‘Simply’ better access to pathology diagnostics is not so simple

In rural and remote health, one of the obstacles to health equity is access to services, such as cancer treatment and mental health specialists, which may be available only in the larger urban or metropolitan centres. A service that is not widely mentioned is pathology, which can provide clinical tools for the diagnosis and management for a range of acute, chronic and infectious diseases. Health professionals working in rural and remote services will be well aware of the long turn-around time for pathology results for their clients.

In the remote Northern Territory many pathology samples are sent to hospitals in Darwin and Alice Springs (taking a few days in many instances) and some of these samples are then sent on to Perth, taking further time before they are analysed and the results become available. Unfortunately, this means that pathology reports may be returned with comments such as:

“The sample was received and processed more than three days after sample collection, some time delay effects have been detected, results may not be reliable.”

This means the health professional in the remote location needs to re-contact the patient, take the sample again, prepare and package it, and send it on the same journey, hoping that this time it will arrive within a suitable timeframe for analysis.

There is a ‘simple’ solution which already operates in many rural and remote areas across Australia, albeit not consistently. Point-of-care pathology testing (POCT) offers a way for non-laboratory trained staff to employ a simple-to-use device to obtain immediate pathology results for a variety of acute, chronic and infectious disease markers.

At the 14^th National Rural Health Conference in Cairns, I delivered a presentation on the Northern Territory POCT Program (http://www.ruralhealth.org.au/14nrhc/program/concurrent-speakers), which has recently been rolled out to all remote health services across the Territory. This program now ensures that all remote Territorians have access to immediate pathology results, primarily for acute care markers, such as Troponin I for acute coronary syndrome, electrolytes, blood gases and lactate. The POCT device used in the NT Program also tests for a number of chronic disease markers such as creatinine and urea for kidney disease and international normalised ratio (INR) for patients on warfarin anticoagulation therapy. The presentation also discussed the significant benefits POCT had on patient safety and substantial cost savings through prevented unnecessary medical evacuations.

After the presentation I was approached by several conference delegates who asked:

“Why has this program not been rolled-out to rural and remote locations more widely?”

One of the priority recommendations of the Conference around digital health also suggested that partnerships be made to facilitate access to consumer-held technologies such as POCT equipment.

While POCT technology is simple to use and has obvious benefits, with the most important being increased patient safety, there are many implementation and management complexities to consider. What are the priority diseases in the local area for which a POCT test is required? Which POCT device should you choose and has it been evaluated for use in the intended setting? Operators must be training and quality testing must be implemented following the recently released guidelines on POCT (http://www.health.gov.au/internet/main/publishing.nsf/Content/health-npaac-poctguid) to ensure the device is used correctly and the results are reliable. The cost of implementing a POCT program as well as the ongoing costs of consumables as many POC tests do not attract a Medicare rebate.

Cost is probably the most significant obstacle to implementing POCT. A Medicare rebate for POC tests conducted in rural or remote areas is required to allow POCT technology to be affordable and thus accessible for patients living in for these geographically isolated areas. However, the Medicare Rebate should be contingent the issues of identifying the targeted diseases, selection of the appropriate device and training and quality testing having been addressed.

More information: http://www.flinders.edu.au/medicine/sites/point-of-care/

The findings of the ‘Immediate pathology results now available for all remote Northern Territorians’ study will be published in an upcoming edition of the Australian journal of rural health.