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Title: The optimisation of HbA1c testing in UK primary care
Author: Hirst, Jennifer
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2016
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Background. HbA1c monitoring to guide diabetes management usually requires more than one clinic appointment. Point-of-care (POC) testing allows testing and treatment changes in a single appointment, but trials of POC HbA1c testing have not been shown to benefit patients and the healthcare system. This work explores how HbA1c testing in primary care could be streamlined using POC testing. It comprises four pieces of work and is guided by complex intervention and test-evaluation frameworks. Methods. Database analyses were used to describe current practice in HbA1c testing and identify factors associated with testing schedules not recommended by guidelines. Systematic review and meta-analysis was used to determine the most accurate POC device. A device was selected to use in a feasibility study to determine how POC HbA1c testing can be used in primary care consultations. Data on recruitment, care pathways, care delivery, satisfaction and behaviour were gathered using data collection forms and questionnaires. Qualitative interviews with patients and clinicians explored perceptions and barriers to POC testing. Results. Database analyses showed that high or low HbA1c testing rates are associated with previous HbA1c levels and use of incentive schemes. Most POC HbA1c devices have a mean negative bias and large variability compared to laboratory methods. When POC HbA1c testing was used in GP practices, nurses used the result to make clinical decisions during the consultation. Nurse consultations were longer than GP consultations (22mins versus 11mins) and POC results were successfully uploaded to patient records. Patients liked POC testing and found it convenient. It helped some link their HbA1c result to recent behaviour. Clinicians found the tests easy to use but were concerned about cost. Conclusion. POC testing can be effectively delivered in primary care but funding mechanisms are needed to encourage adoption. This work could inform the design of a randomised trial to test the effect on patient outcomes.
Supervisor: Farmer, Andrew J. ; Williams, Veronika M. ; Stevens, Richard J. Sponsor: NIHR
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available