A1c results are often not available until after the outpatient visit is completed. Despite the potential for rapid point-of-care (POC) A1c testing to improve the process of diabetes care, published results have not conclusively shown a link to improved diabetes care in primary care settings.
All HealthPartners Medical Group primary care clinics use protocols for nurses to remind patients with diabetes to have A1c tested before upcoming medical appointments. In June 2007, one clinic began POC A1c testing for all diabetic patients who did not have an A1c in the previous six months or if the most recent A1c was more than 1 month ago and >7%. Using generalized linear mixed model regression, we compared diabetes medication intensification at encounters with diabetes patients in the pre-testing period (PRE, 6/1/06-5/31/07, 22932 encounters) and post-testing period (POST, 6/1/07-5/31/08, 27056 encounters) at the intervention clinic and five comparison clinics with no POC A1c testing capability.
The analysis included 3261 patients (mean age 57, 29% minority, median encounters 8/year) seen by 42 primary care physicians (PCP). The median A1c PRE was 7.2% at the intervention clinic, 6.9% at comparison clinics. At intervention clinic encounters, mean days since A1c testing fell from 72 to 44 (with 60% of POST encounters preceded by an A1c less than 1 month old), while there was no change PRE to POST at the comparison clinics. Medication was intensified at 16.3% of PRE encounters with the PCP when A1c was >7% at the intervention clinic, compared to 15.6% at the comparison clinics. Medication was intensified at 12.8% of POST encounters with the PCP when A1c was >7% at the intervention clinic, compared to 12.6% at the comparison clinics (p=0.92). Medication intensification also did not differ at other types of encounters (A1c <7%, not with PCP).
These results add to previous research by examining a mediating step between POC A1c testing and improved glycemic control. Despite more recent A1c test results, medication intensification was not greater in the primary care clinic using POC A1c testing.