Remote testing better for patients – and the economy

On-site pathology testing is allowing rural Australians to receive effective emergency medical treatment close to home, while saving millions in medical evacuations and other healthcare costs.

In a research study funded by the Emergency Medicine Foundation, a Flinders University research team assessed both the medical and cost benefits of using on-site pathology testing, or Point-of-Care-Testing (POCT), for acute medical care in six remote health clinics in the Northern Territory over six months.

Between July and December 2015, the research team evaluated the use of a POCT for 200 patients suffering from either acute chest pain, acute diarrhoea or acute renal failure

The Flinders research team found that having access to POCT avoided the medical evacuation of 60 patients which, when extrapolated Territory-wide, resulted in estimated total cost savings of $21.75 million per year. Access to POCT also enabled early diagnosis, treatment and appropriate evacuation for 21 patients.

Of the 60 unnecessary medical evacuations, the associated cost saving for the 48 chest pain patients was $4674, $8034 for each 10 patients for missed dialysis, and $786 for the two acute diarrhoea cases – translating to NT-wide annual savings of $13.72m, $6.45m and $1.57m respectively once the cost of POCT services was incorporated.

The Flinders study, including Flinders’ Head of Health Economics Associate Professor Billingsley Kaambwa, is one of the first projects in the world to quantitatively evaluate the clinical and economic benefits of POCT in a remote setting, say the project coordinator Ms Brooke Spaeth and Chief Investigator Professor Mark Shephard, from the International Centre for Point-of-Care Testing at Flinders University in South Australia.

“Up to now, we had very little hard research data to support the cost benefits of using POCT,” says Ms Spaeth. “It was mostly anecdotal.

“We now have proof that the POCT technology improved the clinical and operational outcomes for acutely ill patients in remote communities in the Northern Territory.

“It also reduced the need for medical evacuations by up to 35% in the clinical conditions investigated, which has led to significant cost savings for Territory healthcare system,” she says.

The cost savings calculation included all costs associated with using the POCT equipment, including the cost of the devices, consumables, staff time to attend training and to perform the tests and doctor time to consult regarding the patient result as well as any treatment and medications requires.

The benefits of POCT extended even further for Indigenous communities, according to Dr Rodney Omond, who collected the medical data for the study as the Senior Rural Medical Practitioner Education and Training and Clinical Director for Low Acuity Medical Retrievals, Top End Health Service, Northern Territory Department Health.

POCT medical equipment at a remote clinic in the NT.

“Patients in remote Indigenous communities experience a greater sense of isolation if they are removed from their community and put in hospital,” Dr Omond says.

“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,” Dr Omond says.

“As a doctor working in remote communities, I value POCT because it gives me vital information for making timely decisions about patient care.”

Dr Omond says: “POCT means we can now investigate, diagnose, stabilise 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.”

POCT was first introduced to remote health centres in the NT in 2008. Other Australian states have also adopted the technology in rural hospitals, enabling local health professionals to perform a range of pathology tests, with results available in two to 10 minutes.

Emergency Medicine Foundation Chair Dr Anthony Bell said the research team showed that investing in innovation could lead to improvements for rural and remote patients and the healthcare system.

“EMF was pleased to be able to fund this important research, which demonstrates the value of adopting POCT in rural and remote health centres,” Dr Bell says. “This research will hopefully lead to the wider adoption of POCT and better healthcare for all Australians.”

The EMF grant was made possible by industry and philanthropic donations.

The results are published online in the international journal ClinicoEconomics and Outcomes Research.

Spaeth B.A., Kaambwa B., Shephard D.S., Omond R., “Economic evaluation of point-of-care testing in the remote primary health care setting of Australia’s Northern Territory”, ClinicoEconomics and Outcomes Research, 2018; 10: 269–277.

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