Over the last two years we have established the APPN organisation which now has in excess of a thousand registered members including more than 100 GPs. APPN is being used now to enhance the quality of POCT in general practice by providing education and competency testing to those conducting POCT as well as general advice and assistance. If reimbursement for POCT were introduced today, thereby allowing more GPs to conduct POCT, we are confident that APPN could provide an effective support network for this form of testing.
Given how well APPN has been received by all those working in general practice including the RACGP, RCNA, ACRRM, RDWA, Divisions of General Practice and Medicare Locals, we are exploring whether one or more of these organisations with whom we have worked to build APPN, might adopt and fund aspects of the APPN model. This would require approximately $75,000 per year to keep the organisation working to a level where it provides timely and effective support for POCT.
However there remain other aspects of POCT which need to be both researched and put in place before POCT is adopted on a wider scale and reimbursed in general practice. Thus we need to manage a transition from the current APPN organisation and associated activities to an entity that provides and supports activities which are essential to ensuring that POCT is effective and safe for both consumers, patients and healthcare providers.
The issues or projects we have in mind in order to achieve the desired POCT support organisation include:
- Establishment of a POCT accreditation program. This will involve definition of POCT standards (building on those from the GP Trial) and designing a GP friendly implementation model using a joint approach of web based support via APPN and physical inspections by AGPAL. We have met with the CEO of AGPAL who is enthusiastic about working with us and sees our model as a more appropriate one than using other inspection agencies such as NATA. Following the design of a accreditation/inspection process, the project will and test it out with APPN registered practices.
- POCT and patient safety. External Quality Assessment is a fundamental quality requirement of all medical testing including POCT. Yet the requirements for such a program in general practice are different to those of a laboratory and development of a quality in practice program for POCT in general practice will use both patient samples and most importantly patient histories to provide clinical education as well as monitor device performance. This could be done in conjunction with RCPA-QAP but will likely be developed along the lines of the NOKLUS programme from Norway which was discussed with DOHA when the architect of this program, Sverre Sandberg, visited Canberra in March of this year.
- Patient self-monitoring. Many patients are self-monitoring, mainly for blood glucose but also for INR and given the documented effectiveness of the INR self-monitoring and self management, this type of testing is likely to increase. To serve this patient or consumer more effectively we could design a special section on the APPN website which better addresses patient needs. This would also be in response to a significant number of enquiries that that APPN already receives from patients who are self monitoring.
- Special patient groups and GP needs. The focus of general practice POCT in Australia has been primarily on patients with chronic disease. However there is a need for a more systematic assessment of general practice needs in relation to POCT and this could be done through the APPN network. In addition there may also be particular groups of consumers and patients with special needs that could benefit from a POCT alternative to the current model of central laboratory testing such as those who face cultural and language barriers to accessing medical testing. We would like to explore the use of POCT to facilitate better access for such patients.
Andrew St John
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