scholarly journals Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

2021 ◽  
Author(s):  
Brooke Spaeth ◽  
Susan Matthews ◽  
Mark Shephard
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Point Of Care ◽  
Perinatal Care ◽  
Full Potential ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Settings ◽  
Laboratory Services ◽  
Operating Theatres

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.

scholarly journals The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia

2020 ◽  
Vol 144 (11) ◽  
pp. 1372-1380
Author(s):  
Mark Shephard ◽  
Anne Shephard ◽  
Susan Matthews ◽  
Kelly Andrewartha
Keyword(s):  
Infectious Disease ◽  
Point Of Care ◽  
Health Sector ◽  
Lessons Learned ◽  
Full Potential ◽  
Rural And Remote ◽  
Point Of Care Testing ◽  
Primary Care Settings ◽  
Remote Health ◽  
Rural And Remote Health

Context.— Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. Objective.— To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. Data Sources.— Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation. Conclusions.— Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.

scholarly journals Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Jacy Zhou ◽  
Rebecca Blaylock ◽  
Matthew Harris
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Service Delivery Models ◽  
Primary Care Settings ◽  
The Uk ◽  
Delivery Models ◽  
Low And Middle Income

Abstract Background In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion. Conclusion The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.

Mental health and its social determinants

2018 ◽  
pp. 459-464
Author(s):  
Mirai Chatterjee
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Social Determinants ◽  
Mental Health Policy ◽  
Emerging Countries ◽  
The Self ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Settings ◽  
Services Integration

Women show higher rates of many psychiatric disorders. They also look after ill family members, adding to their distress and stress. They are more likely to face poor social conditions such as overcrowding poverty and insecure employment. The Self Employed Women’s’ Association was established nearly 50 years ago. It supports and empowers women and this chapters draws some observations that may help others in low- and middle-income countries. The chapter illustrates a need for major changes in mental health policy and implementation, especially in relation to health care in primary care settings with appropriate access to referral services. Integration of public health and primary care is a possible option. Policymakers and legislators in India and other emerging countries need to work with civil society and localpeople to develop and deliver ways in which social determinants of mental health can be addressed, and with peopleat the centre of all efforts.

Use of DNA sequencing for noncommunicable diseases in low‐income and middle‐income countries' primary care settings: A narrative synthesis

2018 ◽  
Vol 34 (1) ◽  
Author(s):  
Luz Maria González‐Robledo ◽  
Edson Serván‐Mori ◽  
Anaid Casas‐López ◽  
Sergio Flores‐Hernández ◽  
María Lilia Bravo ◽  
...  
Keyword(s):  
Primary Care ◽  
Dna Sequencing ◽  
Low Income ◽  
Noncommunicable Diseases ◽  
Narrative Synthesis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Settings

scholarly journals Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1253
Author(s):  
Imran Shahid ◽  
Abdullah R. Alzahrani ◽  
Saeed S. Al-Ghamdi ◽  
Ibrahim M. Alanazi ◽  
Sidra Rehman ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Point Of Care ◽  
Public Health Care ◽  
Clinical Experiences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Plans ◽  
Care Cascade ◽  
Reflex Testing ◽  
Developed Nations

The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO’s set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this ‘silent epidemic’ worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a ‘test and treat’ strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.

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