**Abstract**

Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.

**Keywords:** Primary health care, point-of-care testing, patient-centred care, remote, Australia

### **1. Introduction**

Primary health care describes the first contact an individual with a health concern has with the health system that is not related to a hospital visit. This may include health promotion, prevention, early intervention, treatment of acute conditions, and management of chronic conditions or infectious disease [1].

In 2015–2016, the proportion of the Australian health budget spent on primary health care (approximately 35%, representing approximately \$AUS 59 billion) was similar to that of country's hospital services (39%, representing approximately \$AUS 66 billion), reflecting the vast and diverse geographical and cultural requirements for health care services in the country [2]. In rural and remote Australia, healthcare services in primary care differ to that in urban or metropolitan areas. Primary healthcare facilities are generally small, with less infrastructure to provide a broad range of health services to a wide geographically distributed population [3]. In addition to a lack of resources, the health of those living in rural and remote Australian locations is also poorer, with the life expectancy for both males and females decreasing with increasing remoteness [3]. The workforce of Australian rural and remote primary health care relies more on general practitioners (GPs) to provide health care services, either on-site, or more recently via telehealth consultations [4, 5]. The remote primary healthcare sector is also largely supported by nurses and Aboriginal Health Practitioners [6]. Due to the high proportion of Aboriginal and Torres Strait Islander people living in remote Australia, health services in these regions are provided by either: (i) Aboriginal Community Controlled Health Services (ACCHOS), which are funded by the Australian Government and administered by a Board comprising Aboriginal and Torres Strait Islander representatives from the respective community or (ii) State or Territory funded health services [7]. With the burden of acute, chronic, and infectious diseases amongst Aboriginal and Torres Strait Islander people higher than that of the non-Indigenous population and the highest Indigenous disease rates correlating with degree of geographic remoteness [3], the overarching Indigenous governance of ACCHOs assists in the delivery of culturally safe health services to address health inequity in Australia [7].

Point-of-care (POC) testing refers to pathology testing performed in a clinical setting at the time of patient consultation, generating a rapid test result that enables timely clinical decision making for patient care [8]. POC testing has proven to be a transformative and life-changing technology for health services and patients in remote Australian communities. From the patient perspective, POC testing provides a convenient and accessible 'one-stop' health service. In this context, POC testing empowers the patient to be accountable for their own health, eliminating the need for multiple follow-up visits to the health services to access diagnostic test results and commence treatment or other interventions. It is also assumed that POC testing reduces patient anxiety associated with waiting for pathology results as test results can be obtained quickly and discussion with the treating clinician can commence immediately. From a clinical perspective, POC test results allow the health practitioner to make immediate and informed decisions for patient management, including the rapid initiation of treatment and/or alternative health intervention strategies. From a cultural perspective, POC testing has enabled Aboriginal and Torres Strait Islander people without life-threatening conditions to be safety monitored and/or treated in their own community [9]. Thus, POC testing not only averts costly medical evacuations, but also allows First Nation people to remain on 'Country' with community and cultural support during the recovery period. Additionally, POC testing assists remote communities by building local health workforce capacity and facilitating an extended scope of practice for Aboriginal Health Practitioners, who can be trained to conduct POC testing. In qualitative surveys, Aboriginal Health Practitioners reported being trained and competent in POC testing as "empowering them to care for patients in their local communities" [10].

*Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care DOI: http://dx.doi.org/10.5772/intechopen.100375*
