Training at Umoona Tjutagku Health Service,
Coober Pedy SA; February 2006
The Australian Government-funded national QAAMS Program provides a culturally appropriate and clinically effective diabetes management service for Aboriginal and Torres Strait Islander people through the use of on-site point-of-care pathology testing (POCT) for haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) that is conducted under a quality management framework.
- ‘QAAMS’ stands for Quality Assurance for Aboriginal and Torres Strait Islander Medical Services.
- Diabetes and its principal complication, renal disease, are responsible for a significant burden of morbidity, mortality, social and cultural trauma in Australia’s Aboriginal and Torres Strait Islander people.
Type 2 Diabetes and Indigenous Australians
- The prevalence of diabetes is 3 to 4-times higher at any age than the general population
- In some communities up to 30% of all adults have diabetes
- Diabetes occurs at an earlier age of onset than the general population
- Indigenous Australian experience 12 to 17-times more deaths due to diabetes than the general population
Renal Disease and Indigenous Australians
- Rates of end-stage renal disease (ESRD) in Indigenous Australians are 9-times that of the general population
- In some parts of Australia, rates of ESRD have reached epidemic proportions
- Rates of ESRD in Indigenous Australians doubled every four years from 1985 to 1996
- Diabetes is the primary cause of ESRD, with 47% of all cases of ESRD being directly attributable to diabetes
- A point-of-care (POC) test is a pathology test that is performed:
- On a small portable medical device
- in the QAAMS Program, we use the DCA 2000/Vantage device (marketed in Australia by Siemens Healthcare Diagnostics, formerly Bayer Diagnostics) which is very simple to use with appropriate training
- Using a very small sample size
- just a fingerprick of blood (for HbA1c) or a drop of urine (for ACR) is required to perform the POC tests on the DCA 2000/Vantage; the fingerprick test in particular is less stressful for the client than venipuncture
- On-site in the Aboriginal medical service at the time of consultation with the client
- ensuring community control and ownership is enhanced and providing a convenient and accessible service for the client with no follow-up visit required to get their laboratory results
- With the result immediately available for the doctor and the client
- enabling an informed clinical decision to be made ‘on the spot’ about diabetes management.
In the QAAMS Program, the point-of-care testing (POCT) is performed primarily by the Aboriginal Health Worker – thus the Aboriginal Health Worker (AHW) has a pivotal role in the day-to-day operation of the QAAMS Program and experiences a strong sense of empowerment in his/her role as a POCT operator.
POCT is particularly useful for rural and remote communities who may be geographically isolated and/or have limited access to laboratory services.
- On a small portable medical device
- Two POC tests are performed as part of the QAAMS Program; namely Haemoglobin A1c (HbA1c) and Urine albumin:creatinine ratio (ACR).
- HbA1c is a blood test, which provides an assessment of how well a person’s diabetes has been controlled over the preceding three months.
- Urine ACR is a urine test which identifies early signs of renal disease, the main complication of diabetes.
- The unique quality management framework provided by the QAAMS Program is modelled on standard laboratory practices and ensures that POCT results from the DCA 2000/Vantage are of the highest analytical quality and are appropriate for client management. Our QAAMS quality management framework is the first of its type for an Indigenous health program anywhere in the world.