title: Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care.
abstract: BACKGROUND
  In remote Australia timely access to pathology results and subsequent follow-up of patients for treatment is very challenging due to the long distances to the nearest laboratory. Point-of-care testing (POCT) offers a practical solution for pathology service provision in such remote communities. Since 2008, POCT for haemoglobin A1c (HbA1c) has been conducted in remote Northern Territory (NT) health centres for diabetes management of Indigenous patients through the national Quality Assurance in Aboriginal and Torres Strait Island Medical Services (QAAMS) Program.
  
  
  METHODS
  Point-of-care testing HbA1c results performed on Indigenous diabetes patients in the NT from July 2008 to April 2011 was accessed via the NT's electronic patient information system. Patients who had three or more HbA1c results performed by POCT across this period were assessed to determine their overall change in glycaemic control. An audit of 40 of these Indigenous diabetes patients (who exhibited a decrease in HbA1c levels of more than 1.5%) was undertaken to compare clinical and operational efficiency of POCT versus laboratory testing over an equivalent time period (15 months).
  
  
  RESULTS
  No change in glycaemic control was observed when these patients received laboratory HbA1c testing prior to the introduction of POCT. Long turnaround times for receipt of results and follow-up consultation with patients were identified during this period, compared to immediate receipt and actioning of results using POCT. Frequency of HbA1c testing was higher with POCT than for the laboratory.
  
  
  CONCLUSIONS
  This audit demonstrates that POCT can significantly improve the timeliness and clinical follow-up of pathology results in remote locations, while also reinforcing the clinical and cultural effectiveness of POCT and its critical role in assisting to improve diabetes management in Indigenous Australians.
authors.affiliation: Level 3 West Wing, Sturt Campus, Flinders University, Bedford Park, South Australia, 5042, Australia.. brooke.spaeth@flinders.edu.au.
authors.forename: Brooke A
authors.initials: BA
authors.lastname: Spaeth
authors.affiliation: Level 3 West Wing, Sturt Campus, Flinders University, Bedford Park, South Australia, 5042, Australia.. mark.shephard@flinders.edu.au.
authors.forename: Mark D S
authors.initials: MD
authors.lastname: Shephard
authors.affiliation: Unit 2C, Casuarina Plaza Casuarina, Darwin, Northern Territory 0811, Australia.. steven.schatz@nt.gov.au.
authors.forename: Steven
authors.initials: S
authors.lastname: Schatz
mesh_terms: D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy; D057286:Electronic Health Records; D006442:Glycated Hemoglobin / Q000032:analysis*; D006303:Health Services, Indigenous; D006801:Humans; D015876:Northern Territory; D019095:Point-of-Care Systems; D019035:Rural Health Services; D012424:Rural Population; D013997:Time Factors; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D006442:Glycated Hemoglobin
keywords: Australia/Pacific; Diabetes; Evidence-based Care