Point of care testing to improve glycemic control

Int J Health Care Qual Assur. 2008;21(3):325-35. doi: 10.1108/09526860810868256.

Abstract

Purpose: The purpose of this paper is to pilot-test the feasibility and impact of protocol-driven point-of-care HbAlc 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, HbAlc 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 HbAlc levels before the intervention, vs. 100 percent post-intervention (p < 0.001). Only 28.6 percent of patients with HbAlc 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Community Health Centers / organization & administration
  • Diabetes Mellitus / blood*
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Nurses
  • Physicians
  • Pilot Projects
  • Point-of-Care Systems / organization & administration*
  • Quality Assurance, Health Care / organization & administration*

Substances

  • Glycated Hemoglobin A