Point of CARE testing in a general practice setting trial

The University of Adelaide, with funding from the Australian Government, Department of Health and Ageing (DoHA) is currently conducting a large research Trial investigating and evaluating the clinical effectiveness, cost effectiveness and safety of point of care testing (PoCT) in general practice. The Trial is of considerable national significance. In 2002, DoHA commissioned a review for the Medical Services Advisory Committee (MSAC) on the role and value of point of care testing in Australia. This report highlighted the potential advantages of PoCT, particularly in rural and remote practices, but concluded that further evidence needed to be collected concerning the clinical and economic benefits as well as the analytical performance of PoCT in the community setting. The Point of Care Testing Trial will occur in three settings: urban, rural and remote. It will aim to demonstrate whether or not local pathology testing will improve and create more efficient care and be acceptable to both general practitioners (GPs) and their patients. It will also test whether these innovative models can be sustainable and safely implemented in general practice. Approximately 6,000 patients of 60 general practices will participate in this Trial. Patients from half the practices will participate fully in the Trial and have their pathology tests conducted at the GP`s surgery; these will be known as the intervention group, while the other half will act as the control group and have their pathology testing done by the usual pathology group selected by their surgery. Patients eligible to participate in the Trial are those 18 years and over and who have established diabetes, cardiovascular disease or who are taking anticoagulant medicine such as Warfarin. There will be four tests used for the Trial. These four tests are: Haemoglobin A1c (HbA1c): a blood test for monitoring the control of diabetes in patients with established diabetes. Urine Albumin:Creatinine ratio (ACR): a urine test for detecting and, in this Trial, monitoring microalbuminuria (early renal disease) in patients with established diabetes. Lipids: a blood test that measures different blood fats (total cholesterol [TC], high density lipoprotein [HDL] cholesterol, and triglyceride [TGL] in patients in this Trial who have hyperlipidaemia and who are taking lipid lowering drugs. International Normalised Ratio (INR): a blood test that measures clotting time in patients receiving oral anticoagulant therapy (such as Warfarin). Three different testing devices will be used in this Trial. These are the DCA 2000 (HbA1c and urine ACR [micralbuminuria]); the Cholestech LDX (blood lipids); and the CoagChek S (INR). All devices and consumables will be supplied to practices for the life of the Trial.