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Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice

Author

Listed:
  • Troels Kristensen

    (COHERE, Department of Public Health & Research Unit of General Practice, University of Southern Denmark, 5000 Odense C, Denmark)

  • Frans Boch Waldorff

    (Research Unit of General Practice, University of Southern Denmark, 5000 Odense C, Denmark)

  • Jørgen Nexøe

    (Research Unit of General Practice, University of Southern Denmark, 5000 Odense C, Denmark)

  • Christian Volmar Skovsgaard

    (COHERE, Department of Business and Economics, University of Southern Denmark, 5230 Odense M, Denmark)

  • Kim Rose Olsen

    (COHERE, Department of Public Health & Research Unit of General Practice, University of Southern Denmark, 5000 Odense C, Denmark)

Abstract

Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were “POCT clinics” was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes.

Suggested Citation

  • Troels Kristensen & Frans Boch Waldorff & Jørgen Nexøe & Christian Volmar Skovsgaard & Kim Rose Olsen, 2017. "Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice," IJERPH, MDPI, vol. 14(11), pages 1-14, November.
    • Handle: RePEc:gam:jijerp:v:14:y:2017:i:11:p:1363-:d:118144
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    References listed on IDEAS

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    2. Kristensen, Troels & Rose Olsen, Kim & Sortsø, Camilla & Ejersted, Charlotte & Thomsen, Janus Laust & Halling, Anders, 2013. "Resources allocation and health care needs in diabetes care in Danish GP clinics," Health Policy, Elsevier, vol. 113(1), pages 206-215.
    3. Sophia Rabe-Hesketh & Anders Skrondal, 2012. "Multilevel and Longitudinal Modeling Using Stata, 3rd Edition," Stata Press books, StataCorp LLC, edition 3, number mimus2, January.
    4. Tjur, Tue, 2009. "Coefficients of Determination in Logistic Regression Models—A New Proposal: The Coefficient of Discrimination," The American Statistician, American Statistical Association, vol. 63(4), pages 366-372.
    5. Rudkjøbing, Andreas & Vrangbaek, Karsten & Birk, Hans Okkels & Andersen, John Sahl & Krasnik, Allan, 2015. "Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark," Health Policy, Elsevier, vol. 119(8), pages 1023-1030.
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    Cited by:

    1. Troels Kristensen & Kim Rose-Olsen & Christian Volmar Skovsgaard, 2020. "Effects of Point-Of-Care Testing in General Practice for Type 2 Diabetes Patients on Ambulatory Visits and Hospitalizations," IJERPH, MDPI, vol. 17(17), pages 1-16, August.

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