Provider Deferred Decisions on Hemoglobin A1c Results: A Report from the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN)

Abstract

Background: Hemoglobin A1c (HbA1c) results are generally reviewed several days after office visits. The clinical decisions on elevated HbA1cs may be complex and are rarely urgent. Providers may elect to defer the decision or its implementation to a future clinical encounter.Objective: To determine the occurrence rate, predictors, and eventual decision outcomes for HbA1c deferred decisions.Design: Provider questionnaire completed when HbA1c results from type 2 diabetes patients were reviewed, followed by a chart review on deferred cases 6 months later.Participants: Providers at 19 Colorado primary care clinics. Measurements: For HbA1c >7%, whether the decision or its implementation was deferred. In deferred cases, whether a clinical decision was eventually made.Results: Of the 311 HbA1cs >7%, 31 (10.0%) had deferred decisions. In multivariate analysis, deferred decisions were more likely in African Americans (odds ratio [OR] 4.91, 95% CI 1.81, 13.3) and less likely when the patient's usual provider reviewed the HbA1c (OR 0.40, 95% CI 0.18, 0.90). In the chart review, for deferred cases (n ‫؍‬ 18), a clinical decision was made in 14 cases, usually at the next clinical encounter. In 4 cases, the HbA1c was never addressed.

The Impact of Point-of-Care A1C Testing on Provider Compliance and A1C Levels in a Primary Setting

“…Clinical intervention is recommended for A1C greater than 8% and is to be considered for A1C between 7% and 8%. 1,6 Clinical decisions regarding A1C result are an important factor in obtaining controlled glycemic effect. Although the mean A1C is improving, many patients are still not at an optimal level; intensification of diabetes management can achieve this goal.…”

“…Communications with the patients and subsequent interventions are therefore often delayed. 6 In response to these issues, POC A1C testing has been developed to check the A1C when the patient presents for care in the office. 11 Point-of-care A1C helps the provider make clinical decisions while the patient is being evaluated by the provider.…”

Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report

“…The SNOCAP networks have successfully used this method of data collection previously. [17][18][19] We initially analyzed the patient encounter forms and clinician information forms separately. Data were checked for consistency in terms of general responses and responses to questions nested in the forms (questions 7 and 9 from the patient encounter form; question 5 from the clinician information form).…”

Strategies for Developing and Sustaining Patient and Community Advisory Groups: Lessons from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) Consortium of Practice-Based Research Networks

“…This is known as the Garry Haynes ethic, named after the farmer, and serves as the guidepost for the work of the HPRN and C.A.C. 26,27 Members were invited to serve as patient experts, fully involved in research processes. The mission of the PAC is to bring together patients from CaReNet practices to advise and guide projects from inception to dissemination.…”