An innovative Australian point-of-care model for urine albumin: creatinine ratio testing that supports diabetes management in indigenous medical services and has international application

Ann Clin Biochem 2005;42:208-215
© 2005 Association for Clinical Biochemistry


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Original Articles

MDS Shephard and
JP Gill

RCPA Quality Assurance Programs Pty Ltd, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia;
RCPA Quality Assurance Programs Pty Ltd, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia

Background: Type 2 diabetes is the leading cause of end-stagerenal failure in Australia’s indigenous people. The measurementof urine albumin:creatinine ratio (ACR) as a marker for earlyrenal disease is an important component of the management ofindigenous patients with diabetes.

Methods: An innovative national program (Quality Assurance forAboriginal Medical Services [QAAMS]) for point-of-care (POC)urine ACR testing on the DCA 2000 analyser (Bayer Diagnostics)was established to monitor microalbuminuria in indigenous peoplewith diabetes in 30 Aboriginal and Torres Strait Islander medicalservices across Australia. Aboriginal health workers performthe ACR test. The QAAMS model provides ongoing education andtraining, an annual workshop, monthly quality assurance testingand a telephone help hotline. Quality assurance testing is conductedusing paired, linearly related samples with a wide range ofACR concentrations (1-25 mg/mmol).

Results: The average participation rate across four six-monthlyQAAMS ACR testing cycles was 83%. In all, 94% of 1163 qualityassurance tests performed were within the preset limits of acceptability.The median precision (coefficient of variation percent for ACRquality assurance testing averaged 5.4%, well within desirableperformance specifications. Between-site accuracy was excellent.

Conclusion: This unique POC model for supporting diabetes managementis the first of its type to be developed for indigenous communitiesand has considerable potential to be adopted worldwide.

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