A research team in Australia was able to improve clinical and operational outcomes for acutely ill patients and reduce the need for medical evacuations by 35% by using point-of-care (POC) devices as aids in remote health centers in the country’s Northern Territory. According to the researchers, this is one of the first projects of its kind worldwide to quantitatively assess the clinical and economic benefits of POC testing (POCT) in areas of scarce resources. The study was funded by the Emergency Medicine Foundation (EMF) Australasia and appeared in the journal ClinicoEconomics and Outcomes Research.
Australia’s Northern Territory is scattered with many remote healthcare facilities that have limited resources, staff, and infrastructure to help patients. Because these care centers are not usually located near tertiary care hospitals, air transport is often necessary to deliver acutely ill patients to larger, better equipped facilities.
POCT is widely used in many rural and remote areas of Australia. However, its use for acute care in remote primary healthcare is limited, Brooke Spaeth, BMedSc (Hons), PhD candidate, point-of-care coordinator for the Northern Territory Point-of-Care Testing Program at Flinders University International Centre and the study’s corresponding author, told CLN Stat.
Not much hard data exists on POCT’s cost benefits in remote settings. The team decided to investigate this approach, utilizing the Abbott i-STAT device as a decision aid in emergency medical retrieval situations. This particular device had already been vetted for safety and clinical effectiveness by the team. “The use of the i-STAT device in the remote NT includes tests for cardiac troponin I, electrolytes, blood gases, urea, creatinine, glucose, ionized calcium, and international normalized ratio (INR) with results for each test available in 10 minutes or less,” they explained.
To conduct this study, researchers developed a decision-analytic simulator model, a commonly used mathematical structure that assesses the effect of health technology on patient outcomes under a variety of scenarios, Spaeth explained.
Investigators collected data from 200 patients who presented with chronic renal failure, acute diarrhea, or chest pain at six Northern Territory health centers over a six-month period in 2015. Specifically, they were looking to see if the POCT device would prevent unnecessary emergency medical retrievals and produce cost savings by reducing these evacuations.
The device ended up preventing 60 medical evacuations across the 200 patient cases. Territory-wide, this amounted to an annual cost savings of $21.75 million. In addition, the device made it possible for 21 patients to receive an early diagnosis and treatment and appropriate evacuation for their health issues.
The findings indicate that POCT not only provides clinical, operational, and cultural benefits to patients in remote locations but also significant cost-benefit to the health system, Spaeth said. It also demonstrates to policymakers and funding bodies that a small investment in POCT technology in remote locations, operated under a sound training and quality management framework, will lead to much larger cost savings as well as significant improvements in patient management and outcomes, she added.
It’s true that POCT technology is more expensive than large laboratory devices that have greater economies of scale for patient testing. “However, this study demonstrates that although POCT is more expensive on a cost-per-test basis, the flow-on cost savings POCT can deliver in rural and remote settings significantly outweighs these small differences in costs of the test itself,” Spaeth said.
From an emotional standpoint, fewer transports benefit the patients in these remote communities, who can feel isolated if they’re removed and taken to a hospital, said study co-author Dr. Rodney Omond, senior rural medical practitioner for education and training and clinical director for Northern Territory Department Health’s Low Acuity Medical Retrievals. “POCT means we can now investigate, diagnose, stabilize, and monitor often very sick patients in a medical emergency and, as we showed in this study, provide early treatment for critically ill patients who require evacuation,” Omond said in a statement.
“Patients in remote indigenous communities experience a greater sense of isolation if they are removed from their community and put in hospital,” said Omond. “Having the ability to remain in community for medical care is important for indigenous Australians and that’s what we’ve shown POCT is allowing us to do, which is quite significant as a culturally appropriate outcome.”
Spaeth anticipates that any of POCT models developed by Flinders could translate to other international settings. “However, in low-resource countries, the initial costs associated with implementing POCT are a barrier for the introduction of POCT technology. Therefore, more work needs to be done to make POCT more affordable in these resource-poor locations where demand is high,” she said.