Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study.

Autor:	Saha A; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Andrewartha K; Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia., Badman SG; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Tangey A; Kirby Institute, University of New South Wales, Sydney, NSW, Australia.; Ngaanyatjarra Health Service, Western Australia, Australia., Smith KS; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Sandler S; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Ramsay S; Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia., Braund W; Clinical Universe, Adelaide, Australia.; Flinders Medical Centre, Adelaide, Australia., Manoj-Margison S; Australian Government Department of Health, Canberra, Australia., Matthews S; Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia., Shephard MDS; Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia., Guy R; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Causer L; Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	Journal of medical Internet research [J Med Internet Res] 2023 Sep 01; Vol. 25, pp. e46701. Date of Electronic Publication: 2023 Sep 01.
DOI:	10.2196/46701
Abstrakt:	Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. (©Amit Saha, Kelly Andrewartha, Steven G Badman, Annie Tangey, Kirsty S Smith, Sergio Sandler, Stuart Ramsay, Wilton Braund, Stuart Manoj-Margison, Susan Matthews, Mark D S Shephard, Rebecca Guy, Louise Causer. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.09.2023.)
Databáze:	MEDLINE
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