Qualität in der Primärversorgung Offener Zugang

Abstrakt

Clinical Application of Point-of-Care Testing in the Remote Primary Health Care Setting

Brooke A Spaeth, Mark DS Shephard, Rodney Omond

Background: Point-of-care testing (POCT) enables immediate pathology results to be used for timely clinical action during the patient presentation. While many benefits of POCT for chronic and infectious conditions have been welldocumented, few studies have focussed on the clinical benefits of POCT for acutely ill patients in remote communities.

Aim: To determine the clinical effectiveness of POCT as a decision support tool for triaging acutely ill patients in remote Australia.

Methods: An audit examined three acute medical presentations (patients with acute chest pain, patients with acute exacerbation of renal failure due to a missed dialysis session(s) and patients with acute diarrhoea) at six remote health centres in the Northern Territory where POCT was routinely available. The main clinical outcome was the percentage (%) of patients with each acute presentation who did or did not require evacuation (as a result of POCT measurement).

Results: 200 patient cases met the selection criteria for the presentation types. Of 147 patients with chest pain, 126 patients were not evacuated due to on-site POCT for troponin I; from this latter group, 48 patients (38%) would have been evacuated if POCT was not available. Of 28 patients who missed dialysis sessions, 17 were evacuated, Three of seven patients (43%) identified with non-STEMI through POCT would not have been evacuated if POCT was unavailable. Of 17 patients evacuated with acute renal disease, four (24%) had initial potassium results >6.5 mmol/L; all four received calcium gluconate/resonium medication and serial POCT with decreased potassium levels at evacuation. All 10 patients evacuated with acute diarrhoea received rehydration therapy prior to evacuation.

Conclusion: POCT enabled more informed triaging of acutely ill patients requiring evacuation to a tertiary hospital as well as ruling out the need for evacuation for patients who could remain in the community and be stabilised safely using POCT.