**6. Economic outcomes**

Data which demonstrates the cost effectiveness of POC testing, comparative to laboratory testing, is essential for ensuring the initial feasibility and sustainability of POC testing models worldwide. Previously, our research demonstrated savings of over \$21 million per annum for the NT Government through averted unnecessary medical retrievals as a result of acute i-STAT POC test results in the remote communities within the NT POCT program [15]. Similarly, economic savings have been reported in rural New Zealand hospitals, where an annual cost reduction of more than \$NZ 450,000 was realised from POC testing through a decreased number of hospital transfers and an increase in the hospital discharge rates [34]. In the United Kingdom, a primary care study also reported that POC testing was cost effective, in comparison to laboratory testing, when used to perform routine health checks as the results were available at the first consultation [33]. A review of POC testing health economics in remote primary health care settings also provided general support for POC testing benefits to health services outweighing the associated costs [35]. In Australia, the Medical Services Advisory Committee (MSAC), is an independent, non-statutory committee established by the Minister for Health, that is responsible for the appraisal of new medical services proposed for public funding, including POC testing. MSAC provides advice to the Australian Government on whether a new medical service should be publicly funded, based on an assessment of its comparative safety, clinical effectiveness, cost-effectiveness, and total cost, using the best available evidence. Amendments and reviews of existing Medical Benefits Schedule (MBS) services, including POC tests, are also considered by MSAC. In this regard, evidence-based Australian economic cost-effectiveness data that supports the application of POC testing in primary care is paramount to ensure the economic sustainability of POC testing through public funding models.

#### **7. Key elements of POC testing networks**

Best-practice POC testing models are underpinned by a common set of core elements as illustrated in **Figure 3**. These include: (a) a defined clinical or public health need for POC testing, (b) appropriate site selection, targeting priority populations with high disease prevalence or risk, (c) clinical and cultural governance of the POC testing procedures and patient test results, (d) engagement with the community to ensure patients are educated in understanding the health benefits of POC testing and can be easily linked to appropriate models of healthcare, (e) robust training and competency assessment processes for health professionals conducting POC testing to minimise patient harm, (f) continuous surveillance of analytical quality using internal quality control and external quality assurance programs, with prompt and appropriate actioning to maintain satisfactory analytical quality standards, (g) provision of an intensive level of technical and scientific troubleshooting support to maximise device operation and result quality, (h) connectivity and real-time reporting systems to ensure rapid patient result transmission, complete patient result audit trails and allow appropriate public health notification of required patient infectious diseases (noting that POC connectivity systems can be complex to integrate and sustain in primary care settings and are not always costeffective) and (i) supply and logistical management of equipment, reagents and consumables, often to remote locations with sub-tropical or tropical climates. Once established, ongoing evaluation of the clinical effectiveness and utility, cultural effectiveness, benefits to patient and community, cost-effectiveness, risk management assessments and limitations of each POC testing program is integral to ensure

**Figure 3.** *Key elements of a best-practice point-of-care testing network.*

continual quality process improvement. The sustainability of best-practice POC testing is reliant on the continual development of national and international of POC testing implementation and management policies and robust guidelines that arise from translational research of best-practice POC testing networks [36].

Whilst the POC testing models described have been implemented with financial support from Australian Commonwealth and/or State Governments, several challenges currently exist when considering the sustainability and viability of POC testing in remote locations. These are summarised in **Table 3**. At a local community level, there can be saturation of health services with POC testing network requirements regarding staff capacity. This is particularly evident when individual health services enrol in multiple POC testing programs and experience rapid staff turnover. For ACCHOS, Commonwealth support for targeted POC testing remote staff, to be managed through the national leadership body for Aboriginal Community Controlled Health Organisations (NACCHO) may assist in alleviating future workforce shortages. More broadly, feasibility studies and predictive modelling can be applied to remote primary care scenarios prior to implementation to ensure POC testing networks are scaled to maximise reach and outcome benefits. At a national level, the existing regulatory framework for POC testing performed outside a clinical laboratory setting is somewhat rudimentary, with newer POC technologies superseding the 2015 National Pathology Accreditation Advisory Council (NPAAC) Guidelines for POC testing. Broader clinical acceptance and public health funding of POC test results performed in decentralised Australian primary care settings is reliant of the development and evaluation of a formal regulatory system for bestpractice POC testing performed outside that of an accredited laboratory framework. In addition, further integration of patient POC test results from primary

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


#### **Table 3.**

*Summary of key challenges for POC testing in the primary care setting.*

care settings into patient management systems and/or electronic medical records is required to overcome the current lack of accessibility of historical POC test results which may be useful for patient management (e.g. past history of sexually transmitted diseases). It is only when the current challenges POC testing are overcome that the full benefits of POC testing in decentralised primary care settings can be widely recognised, accepted, and sustained [37].

In summary, POC testing in Australia can be considered a life-changing technology as it can: a) provide equity of access to pathology services in remote and underresourced locations, b) support prompt medical evacuation and public health decisions c) be cost-effective, in comparison to laboratory testing or overall health service savings, if the network scale-up is optimised prior to implementation, and d) has capacity to deliver individualised patient-centred care. If the current challenges and barriers to POC testing sustainability can be further addressed, a wider range of clinical, public health and economic benefits could be realised through new and/or additional POC testing initiatives for high priority, at-risk populations, especially in rural and remote Australian communities.

*Primary Health Care*
