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Point of care testing to improve glycemic control

Point of care testing to improve glycemic control Purpose – The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low‐income patients. Design/methodology/approach – The paper suggests a primary care process re‐design, using point of care finger‐stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit. Findings – The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent ( p =0.40, n =106). For the 69 patients who had both pre‐ and post‐intervention results, HbA1c levels decreased significantly from 8.55 to 7.84 ( p =0.004, n =69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face‐to‐face visit with lab results available, occurred for only 68.6 percent of elevated HbA1c levels before the intervention, vs. 100 percent post‐intervention ( p <0.001). Only 28.6 percent of patients with HbA1c levels >8.0 had their regimens intensified in the pre‐intervention phase, compared with 53.8 percent in the post‐intervention phase ( p =0.03). Research limitations/implications – This was a pilot‐study in one urban health center. Larger group‐randomized controlled trials are needed. Practical implications – The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control. Originality/value – This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Health Care Quality Assurance Emerald Publishing

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Publisher
Emerald Publishing
Copyright
Copyright © 2008 Emerald Group Publishing Limited. All rights reserved.
ISSN
0952-6862
DOI
10.1108/09526860810868256
pmid
18578216
Publisher site
See Article on Publisher Site

Abstract

Purpose – The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low‐income patients. Design/methodology/approach – The paper suggests a primary care process re‐design, using point of care finger‐stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit. Findings – The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent ( p =0.40, n =106). For the 69 patients who had both pre‐ and post‐intervention results, HbA1c levels decreased significantly from 8.55 to 7.84 ( p =0.004, n =69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face‐to‐face visit with lab results available, occurred for only 68.6 percent of elevated HbA1c levels before the intervention, vs. 100 percent post‐intervention ( p <0.001). Only 28.6 percent of patients with HbA1c levels >8.0 had their regimens intensified in the pre‐intervention phase, compared with 53.8 percent in the post‐intervention phase ( p =0.03). Research limitations/implications – This was a pilot‐study in one urban health center. Larger group‐randomized controlled trials are needed. Practical implications – The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control. Originality/value – This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes.

Journal

International Journal of Health Care Quality AssuranceEmerald Publishing

Published: May 2, 2008

Keywords: Diabetes; Primary care; Quality improvement; Redesign

References