Use of home hemoglobin A1c test kits to monitor the effectiveness of diabetes care.
BACKGROUND
Periodic measurement of glycated hemoglobin (HbA1c) is highly recommended for people with diabetes to determine whether their blood glucose is adequately controlled. Quality improvement programs initiated by health plans often focus on ensuring that HbA1c is being monitored in members with diabetes. To focus improvement efforts on members with poor blood glucose control, health plans need to know which members have high HbA1c levels. Recent development of home test kits provides another opportunity for health plans to help members measure their HbA1c and to identify members with high levels.


METHODS
A sample of members from two health plans who were sent HbA1c self-test kits in January 2000 participated in a telephone interview. To understand why members did or did not use self-test kits sent by their health plans, the survey focused on perceived ease of use, outcomes, and normative beliefs.


RESULTS
In the group of 380 members who were interviewed, 170 (45%) used the kit. HbA1c values were > 8 mg/dl in 43%. Among the 170 who used the kit, 160 said that they would use the kit. Their most common reason for using the kit was to find out how well their blood glucose was being controlled (48%). Convenience (12%) was the next most frequent reason for using the kit. Among the 210 members who did not use the kit, 81 members said that they would not or were not sure if they would when interviewed. Their most frequent reason for not using the kit was duplication of tests done by physicians (34%). Others were too busy (12%), wanted to talk with their physician (11%), or had difficulty using the kit (11%).


CONCLUSIONS
Because the majority of health plan members did not use the kit and the majority who did use the kit had HbA1c levels < 8 mg/dl, sending home test kits to members did not result in a high yield of members with elevated HbA1c levels. Physicians' support for use of the kits and efforts to make kits easier to use might increase use. Efforts to avoid duplication of physicians' measurements could make this strategy to identify members with poorly controlled levels of blood glucose more cost-effective, although health plans would not know which monitored members might benefit most from programs to improve care of diabetes.
Rector
T S
TS
Center for Health Care Policy and Evaluation, UnitedHealth Group, MN008-W109, 9900 Bren Road East, Minnetonka, MN 55343, USA. thomas_s_rector@uhc.com
Venus
P J
PJ
Thayer
S R
SR
D001294:Attitude to Health; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000517:prevention & control* / Q000523:psychology; D006442:Glycated Hemoglobin / Q000378:metabolism*; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D008910:Minnesota; D009042:Motivation; D015397:Program Evaluation / Q000379:methods; D019984:Quality Indicators, Health Care; D011933:Reagent Kits, Diagnostic / Q000706:statistics & numerical data*; D012494:Sampling Studies; D012648:Self Care / Q000379:methods / Q000523:psychology / Q000592:standards; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration*
D006442:Glycated Hemoglobin; D011933:Reagent Kits, Diagnostic