**4. Patient-centred outcomes**

POC testing enables the patient to be at the centre of healthcare processes. Diagnostic POC test results are rapidly available within the initial on-site consultation, inform prompt patient management decisions and even may fast-track additional clinical investigations, as required. For the patient, this eliminates the need to attend separate phlebotomy collection services and return for a follow-up visit to discuss laboratory test results, thus making POC testing patient-centric and linkage to care convenient. Other cited patient benefits for POC testing include: (i) increased adherence to diabetes medication [23], (ii) reduced pain and/or anxiety associated with capillary, rather than venous blood collection, particularly for elderly or paediatric patients, and (iii) an increased likelihood of patients consenting to diagnostic testing [24]. Furthermore, the wait for the return of diagnostic test results is a reported cause of anxiety [25, 26], so in this context, POC testing may also reduce overall patient anxiety or stress related to waiting for laboratory test results [27].

In acute care settings, POC testing changes lives, with rapid results informing prompt diagnosis and rapid initiation of patient stabilisation and/or treatment. An example is the use of i-STAT cardiac troponin I POC testing within the NT POCT Program for the immediate diagnosis of non-ST elevation myocardial infarction (non-STEMI) in remote patients [19]. In this scenario, if cardiac troponin I POC testing was not available, non-STEMI events may not be quickly diagnosed and treated [19]. Without POC testing, remote patients who often miss scheduled dialysis due to cultural and community obligations may also become acutely ill. In these cases, the i-STAT POC device can be used to detect critical levels of hyperkalaemia, so that immediate treatment with calcium gluconate to lower cardiac risk can be initiated [19]. In dehydrated patients, with acute vomiting or diarrhoea, i-STAT POC testing facilitates frequent monitoring of the patient's electrolyte levels during stabilisation with IV or oral fluid administration [19]. In these remote primary care settings, POC testing facilitates information to avert the time, inconvenience and cost of unnecessary transfer to a tertiary medical facility. Averting unnecessary medical evacuations can be particularly significant for Aboriginal and Torres Strait Islander people who live in remote communities, where the dislocation from community and Country can cause significant mental distress [28, 29]. Though brief, these examples illustrate how POC testing can be a life-changing technology at the individual patient level, particularly for those who would not otherwise be able to access timely pathology results.

#### **5. Public health outcomes**

Beyond the individual patient level, POC testing programs have the capability to facilitate broader public health benefits. For example, one of the site selection criteria for the COVID-19 POC Program was that primary health care services were located a

minimum of 2 hours' drive from an existing COVID-19 testing laboratory facility and serviced predominately Aboriginal and Torres Strait Islander communities of greater than 500 people. Indicative of the clinical need of the COVID-19 POC testing program for remote, priority communities, by the completion of site enrolment, approximately half of the participating health services were located more than 10 hours' drive from a laboratory testing facility and included several health services located on remote islands requiring dedicated flights to reach mainland COVID-19 testing services [11]. To provide wider COVID-19 testing access, a hub and spoke model was established, whereby nasopharyngeal swab samples were collected from patients in neighbouring spoke communities, placed into virus inactivating molecular transport media and transported to the hub testing sites. The hub and spoke POC testing model expanded total testing capability to approximately one hundred and fifty at-risk communities (from eighty-eight hub testing sites). With over 32,000 patient COVID-19 POC tests performed nationally to date, the Aboriginal and Torres Strait Islander COVID-19 POC testing program has significantly reduced the time required for isolation/quarantining for vulnerable individuals who test negative as the turn-around time for COVID-19 results is reduced from an average three-day turn-around time for laboratory testing to less than one hour per test for POC testing. Applying similar assumptions of community size, remoteness and access to laboratory test facilities as those reflected in the site selection criteria for the COVID-19 POC testing program, mathematical modelling used to inform the Australian Government, indicated that by reducing the time for COVID-19 case identification and isolation from ten days, the COVID-19 transmission rate changed from that associated with an uncontrolled outbreak to a either a significant surge or controlled condition, for reductions of five or three days, respectively [30]. The ability to reduce isolation and quarantining duration for negative COVID-19 cases is particularly relevant to remote communities within Australia, where selfisolation may be difficult due to a lack of suitable housing and/or over-crowding, or impacted by other social and cultural determinants [31]. Most recently, the Aboriginal and Torres Strait Islander COVID-19 POC testing program rapidly scaled-up the number of GeneXpert devices, competent staff and test cartridges available to deliver COVID-19 results required for case identification, contact tracing and public health response in emergency outbreak local government areas of New South Wales (NSW), as opposed to waiting several days for laboratory results [32]. In addition, in outbreak response areas and other under-resourced remote communities, the COVID-19 POC testing program has enabled mobile employees to be rapidly screened using molecularbased COVID-19 testing. In these circumstances, POC testing has assisted with crisis workforce capacity, whilst also providing a level of protection to the local communities by minimising COVID-19 infection transmission risk.

For the TTANGO Program, a significantly improved "time to treat" sexually transmitted Chlamydia and Gonorrhoea infections in comparison to regular test processes was demonstrated by the application of rapid POC molecular-based test results in remote Australian communities [22]. For sexually transmitted diseases, prompt diagnosis and public health notification, patient education and treatment hasten STI contact tracing aiming to decrease the onward and/or vertical transmission of STIs in the community.

For chronic diseases, such as type 2 diabetes and the associated renal complications, the availability of POC testing provides extended scope for consented screening tests of at-risk populations. In these patients, POC testing facilitates linkage to early education of the disease and lifestyle interventions that can afford the patient improved long-term monitoring and improvement of their long-term health outcomes, without a loss to follow-up [33]. Early identification and treatment of chronic disease, such as type 2 diabetes, that slows the progression of disease complications, may in turn may lead to reduced burden on tertiary care facilities.

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