In regards to the article type 2 diabetes: prevention or cure?1 Mary Pierce explains that HbA1c testing compared to the glucose-based test would be a more practical scheme as suggested by the Leicester Group and that ‘People identified as being in the top 50% of diabetes risk using a computer-based risk assessment tool, can be opportunistically offered a HbA1c test to identify those with diabetes and those at high risk who require intensive structured lifestyle intervention and annual HbA1c monitoring’.1 She further states that ‘The Vascular Screening Programme with the diabetes addendum will improve the health of the population ...’’1; a statement with which I agree and hence the search for a method to improve patient compliance in HbA1c testing. For these reasons we can relate our audit that was carried out at The Royal Docks Medical Practice in 2012, in the Borough of Newham, London. The aim was to improve patient compliance in taking the HbA1c tests, that would in turn improve the outcomes and reduce the complications of diabetes and in turn reduce the costs to the NHS.
A list of 54 patients with an HbA1c above 9% in the first cycle of the audit, and 52 patients in the second cycle of the audit were used. In the first cycle (Method A), we posted out blood request forms to all 54 patients, information regarding the times and location of the blood test, and a universal cover letter explaining what the blood test was for.
In the second cycle (Method B), which was employed 3 months after the first cycle, 52 patients were contacted to come to the surgery to discuss their diabetes and book a blood test; this would mean patients would have to make two trips, one to the surgery, and in most cases another to the blood centre on a separate day — as opposed to Method A that required one trip, only to the blood centre.
Patient compliance was improved by 57.4%, and 24.07% of patients had an improved HbA1c below 9% with Method A. With Method B, patient compliance improved by 32.7%, and 7.7% of patients had an improved HbA1c below 9%.
Therefore the key advantages of using Method A is that most importantly 25% of patients had a reduced HbA1c and 55% improved in compliance. It will help to contain the growing costs for the Clinical Commissioning Groups that went live to manage the local health budgets from 1 April 2013. Method A can also be used throughout the UK and for other types of routine blood tests. Furthermore it saves the NHS money through reduced hospital admissions of diabetic emergencies and saves GPs money through fewer referrals. It will benefit GPs by improvement in Quality and Outcomes Framework scores. Improvement in compliance will mean patients will need to take less time off work, therefore less health related work absence.
- © British Journal of General Practice 2013
