Evaluating point of care testing for glycosylated haemoglobin in primary care facilities in the Western Cape

Vos, Johannes Jacobus (2016-03)

Thesis (MMed)--Stellenbosch University, 2016

Thesis

ENGLISH ABSTRACT : Background HbA1c testing helps to reduce the risk of complications associated with diabetes mellitus and is accepted to be an accurate measure of long-term glycaemic control. Immediacy of results through point of care testing can promote early treatment intensification and lifestyle modification. Currently point of care (POC) testing for HbA1C is not available in primary health care facilities in the Western Cape. Aim and objectives The main aim was to explore the effect of POC testing for HbA1C on treatment intensification, patient education, glycaemic control and the amount of patients who would receive an annual HbA1C test. Cost implications and technical quality was also assessed. Methods This was a quasi-experimental study comparing clinics with and without POC testing over a period of 1-year. This assignment reports on half of the larger study and presents data from two clinics. A POC machine for HbA1C was introduced at the intervention site. 150 patients (N=300) were randomly selected from each site. Data was collected retrospectively from the patient records for the preceding 12 month period at baseline and follow up. A peer focus group at the intervention site explored experience and perceptions of staff with POC testing. Technical quality was assessed by monitoring compliance with internal and external quality control. Results There was a significant increase in the % of patients receiving an annual HbA1C (control -8%, POC +24%; p<0.001). The turn-around time for HbA1C results was greatly reduced (control 38.2 days, POC 1.2 days; p<0.001). There was no effect on intensification of treatment or counselling. The effect on glycaemic control must be followed up later. Staff reported that the POC testing was feasible. There was poor compliance with quality control checks. There was an incremental cost to POC testing of R1451 per 100 tests. Conclusion The increase in patients having an annual HbA1C test and reduced turn-around time for results will hopefully result in improved feedback to patients and glycaemic control. The lack of a response in terms of treatment and counselling to the results suggests a degree of clinical inertia that should be addressed in other ways. The initial results do not suggest a favourable cost to benefit ratio.

AFRIKAANSE OPSOMMING : Geen Afrikaanse opsomming geskikbaar nie

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