Utilizing point-of-care A1c to impact outcomes – can we make it happen in primary care?

Abstract

Purpose of reviewHemoglobin A1c testing provides a marker of glycemic control and is the standard for diabetes risk assessment. According to the Centers for Disease Control (CDC), only 67.3-71.4% of diabetic patients between 2011 and 2016 had at least two A1c levels tested per year. Moreover, 27.8% had uncontrolled diabetes with an A1c of 8.0%, increasing the risk of microvascular complications. Lack of monitoring presents a significant barrier, and improving ease of testing could improve glycemic control. Recent findingsPoint-of-care (POC) A1c testing, obtained via capillary blood with results provided in 5-6 min, is available and used frequently in endocrine clinics. However, POC A1c testing is not standard in primary care, where 90% of type 2 diabetes patients are treated. Barriers include access and costs of POC A1c machines and standardization of testing in the primary care setting. Review of literature, however, suggests that POC A1c testing in primary care may lead to A1c reduction whereas being potentially cost-effective and strengths the patient-physician relationship. Summary POC A1c testing in primary care, if widely available and integrated into workflow, has the potential to positively impact diabetes care. Real-time feedback may change patient and physician behaviors, allowing earlier therapeutic intensification.

Determinants for scalable adoption of autonomous AI in the detection of diabetic eye disease in diverse practice types: key best practices learned through collection of real-world data

“…Across all health centers, if a provider identified an eligible patient during the visit, they would place an order and schedule the exam for the end of the visit. LumineticsCore Exam Capture & Provider Consult (patient visit): The value of point-of-care testing is that it streamlines the referral system, helps with clinical decision-making, and strengthens the patient-provider relationship ( 4 ). For instance, some clinics opt to expand roles using nurse navigators (also called diabetes coordinators) to complete exams.…”

“…The general challenges of frontline care clinical workflow have been well documented in the literature (4,18). Standardization of patient intake, streamlining of care management processes, patient flow coordination, office visit documentation, and use of electronic record systems have been extensively measured and optimized in the primary setting (19)(20)(21)(22)(23).…”

“…Much has been published about the responsible adoption of healthcare AI so that it benefits patient outcomes and is shown to be safe and effective, mitigates potential bias, and is developed under an ethical framework ( 1 – 3 ). As described elsewhere, adoption of these new technologies requires meeting the expectations of multiple stakeholders and, at the same time, seamlessly integrating into workflow in the clinical setting ( 4 ). Stakeholder considerations for scalable adoption include varying perspectives: for health center staff, ease-of-use and seamless integration with existing workflow; for providers, acquisition costs, patient benefit, and payer reimbursement; for payers, utilization, costs of delivering the service, patient benefit, and cost-savings over standard-of-care; and for regulators, proven safety and efficacy in the targeted population, elimination of potential bias, and adherence to ethical frameworks in the Total Product Lifecycle (TPLC) ( 5 ) for AI systems in healthcare ( 2 , 3 , 6 ).…”

“…Primary care workflows commonly vary by practice, and at times, for individual providers ( 4 , 7 , 8 ). Furthermore, integration of a new technology into clinical workflow has equity implications related to intended use and need to be addressed early in the design phase of the product development lifecycle ( 6 ).…”

Facilitators and barriers of the implementation of point-of-care devices for cardiometabolic diseases: a scoping review

“…POCT is as useful as laboratory testing to identify risk factors, diagnosis and continuous monitoring of cardiometabolic diseases such as hypertension, diabetes, or congestive heart failure, among others [ 3 , 4 ]. POCT devices can test single parameters such as haemoglobin A1c [ 5 ], glucose [ 6 ], lipid profile [ 6 ], or serum creatinine [ 7 ] one at a time, or multiple haematological parameters at once with multiplex cartridges [ 8 , 9 ]. Their use in limited-resource settings is attractive because they grant results within minutes, are easy-to-use, and are small in size, which makes them easy to place in clinics with limited space or—for some devices – being portable.…”