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Impact of Order Restrictions on Hemoglobin A1c Requests at Primary Health Care Centers in Riyadh, Saudi Arabia
Maha Alakeely1,2, Nazish Masud3, Fatemah Bin Saleh1,2
1Department of Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Insights
Policy restrictions significantly reduced early hemoglobin A1c (HbA1c) testing in Riyadh primary care. However, early testing remains common, suggesting policy alone is insufficient for optimal diabetes management.
Area of Science:
- Endocrinology
- Public Health Policy
- Primary Care Medicine
Background:
- Hemoglobin A1c (HbA1c) testing is crucial for diabetes management.
- Inappropriate HbA1c ordering can lead to unnecessary healthcare costs and patient burden.
- Evaluating the impact of policy interventions on physician ordering practices is essential for healthcare quality improvement.
Purpose of the Study:
- To assess the effect of policy intervention on physician ordering of HbA1c tests.
- To analyze changes in early and inappropriate HbA1c testing rates before and after policy implementation.
- To identify predictors of early HbA1c testing in primary care settings.
Main Methods:
- Retrospective study of 16,290 patients aged over 18 in Riyadh primary care centers (October 2020 - August 2023).
- Analysis of HbA1c ordering data before and after policy restrictions.
- Logistic regression used to determine factors influencing early HbA1c testing, defining early testing based on standard criteria.
Main Results:
- Approximately 89.6% of HbA1c tests were deemed inappropriate.
- Policy restrictions led to a 70.3% reduction in the odds of early testing (OR = 0.297).
- Younger age and lower HbA1c levels were associated with increased odds of early testing.
Conclusions:
- Policy restrictions demonstrated a significant reduction in early HbA1c testing.
- Early and inappropriate HbA1c testing remains a prevalent issue, even post-intervention.
- Further investigation into physician perspectives is needed to optimize testing practices and improve diabetes care.
Purpose:
The aim of the study was to assess the effect of policy intervention on the physician ordering of HbA1c for the patients seen at the primary health care center in Riyadh, Saudi Arabia.
Methods:
The study included patients over the age of 18 for whom HbA1c tests were ordered before and after the policy restrictions were implemented at the three main Primary Health Care Centers under the Ministry of National Guard Health Affairs (MNGHA) in Riyadh, between October 2020 and August 2023. Several data management steps and restrictions were carried out to identify the patients seen before and after the intervention and controlled for the confounders. The outcome variable was inappropriate testing, and early testing was defined based on standard cutoffs of HbA1c, diabetic control, and patient history. The logistic regression analysis was used to identify predictors for early testing.
Results:
Among 16,290 participants, the mean age was 50 ± 16 years, with a predominance of females (66.5%). Approximately 22.3% of participants were diabetic, and the mean HbA1c level was 6.2 ± 1.55%. About 89.6% of tests were deemed inappropriate based on criteria for glycemic control, diabetic status, and duration of testing. Policy restrictions led to a 70.3% reduction in the odds of early testing (OR = 0.297, 95% CI: 0.246-0.358, p < 0.001). Each unit increase in HbA1c decreased the odds of early testing by 1.517 (OR = 0.219, 95% CI: 0.193-0.249, p < 0.001). Additionally, younger participants were more likely to undergo early testing, with odds decreasing by 3% for each additional year of age (OR = 0.970, 95% CI: 0.966-0.974, p < 0.001).
Conclusion:
We conclude that policy restriction alone might not be effective in reducing the burden of early testing. The early testing tendency was less in the post-intervention period. However, early testing was a common practice in both pre- and post-intervention phases. As physicians are the ones ordering the tests, deeper insight is needed from the physician's perspective.
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