Point-of-care test MBS rebate empowers GPs, diabetes patients

AROUND 1.8 million Australians are living with diabetes, including 500 000 with undiagnosed type 2 diabetes. GPs play an important part in managing the global epidemic that is type 2 diabetes.

Earlier in 2021, federal Minister for Health Greg Hunt announced that $2.1 million would be allocated to the reimbursement of glycated haemoglobin (HbA_1c) point-of-care tests for people with diagnosed diabetes. Since 1 November, routine diabetes point-of-care testing is reimbursed through the Medicare Benefits Schedule (MBS). This means GPs can choose to monitor their patients’ health without always referring them to a pathology laboratory.

GPs and nurse practitioners can claim Medicare rebates through the new items 73812 and 73826 if they are using methods and instruments certified by the National Glycohemoglobin Standardization Program.

There are only around 500 endocrinologists in Australia and well over 25 000 GPs, so the onus is on GPs to treat type 2 diabetes early in the course of the disease. With type 2 diabetes, early glycaemic control is important in order to avoid developing long term complications and requiring treatment with insulin. Complications associated with the condition include amputations, blindness, kidney failure, heart attacks and strokes.

The HbA_1c test is performed every 3 months in people with diabetes to review their average glucose levels. The result helps health care professionals determine whether treatment, diet or exercise levels should be adapted. In Australia, patients are generally referred to a pathology laboratory for a blood test and results can take a few days to be returned.

Point-of-care analysers usually require a drop of blood from a finger prick to produce quick and highly accurate results, some giving a result within 3 minutes. The advantage of having HbA_1c point-of-care testing is that health care professionals can decide how a patient’s therapy will be escalated and lifestyle will be tightened up on the spot, without requiring a second appointment.

While point-of-care testing would benefit every patient with diabetes in Australia, it is particularly well suited to clinics in regional and rural areas with limited access to pathology laboratories. This avoids patients having to drive long distances for a blood test, possibly having to take time off work to do so.

Practices that serve culturally and linguistically diverse communities, such as my place of work in Sydney, would also benefit from this technology. One of the challenges with traditional pathology is losing patients to follow-up, as results usually come back within 24–48 hours. Depending on the test result, the patient either comes in to see us or speaks to us over the phone, and after that time has lapsed, it may be harder to secure a second appointment with the patient.

A report from 2016 shows that patient adherence to pathology requests is poor, with up to 31% of patients not receiving requested pathology tests in Australia. This presents a significant barrier to successful monitoring of chronic conditions such as diabetes.

A study has demonstrated a reduction of up to 61% in patient revisits after the implementation of point-of-care testing. Fewer follow-up medical appointments may contribute to a reduction in diabetes care costs and inconveniences such as travel, parking, and potentially lost wages, which benefits both the patient and the economy.

To qualify for the MBS reimbursement, clinics will need to be accredited under the Australian Commission on Safety and Quality in Health Care’s National General Practice Accreditation Schemeagainst the Royal Australian College of General Practitioners’ Standards for general practices and Standards for point-of-care testing.

For health care professionals considering point-of-care testing technology, it is important to choose an easy-to-use and highly accurate system that can provide results equivalent to those from a laboratory.

A platform that offers more testing opportunities has additional advantages, particularly for adherence to guidelines around the diabetes annual cycle of care. This annual check-up involves pathology tests to assess the HbA_1c level, lipids, and kidney health, alongside other health assessments. Some point-of-care systems are highly accurate and offer multiple assays including HbA_1c, a full lipid panel, urinary albumin creatinine ratio and C-reactive protein, with results available in just a few minutes from a small fingerstick blood sample or urine sample.

The COVID-19 pandemic and many lockdowns affecting Australia resulted in a drop in diabetes pathology testing, which could result in a wave of long term complications and undiagnosed cases. This new point-of-care testing reimbursement means that people with type 2 diabetes can be managed in a patient-centric manner, and allows GPs to monitor their patients more closely.

Dr John Barlow is a GP based in Bankstown, NSW with special interests in the management of type 2 diabetes, skin cancer, and work-related injuries.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.