Clinical decisions regarding HbA1c results in primary care: a report from CaReNet and HPRN.
OBJECTIVE
To describe decisions made by primary care providers on elevated HbA(1c) results and their reasons for not intensifying therapy.


METHODS
In this cross-sectional study, a provider survey was administered in two practice-based research networks when HbA(1c) results were reviewed on all nonpregnant patients >18 years old with type 2 diabetes. Univariate and Mantel-Hantel analyses assessed associations between patient characteristics and clinical decisions.


RESULTS
A total of 483 surveys were completed by at least 88 providers at 19 clinics. Most patients were female (62.5%), mean age was 60 years, and 28.6% were Hispanic. The overall action rate on HbA(1c) results >/=7% (n = 294) was 70.7%. Patients who were black or had Medicare without medication insurance had lower rates of action on HbA(1c) >/=7 and >/=8%, respectively (P < 0.05). The most common reasons providers reported for inaction were "patient improving/doing well," "competing demands," and "hypoglycemic risk."


CONCLUSIONS
Primary care providers generally adhere to national glycemic control guidelines, although there may be disparities in black patients and patients without medication insurance coverage. A variety of reasons were given when control was not intensified.
Parnes
Bennett L
BL
Department of Family Medicine, Division of Geriatrics, University of Colorado Health Sciences Center, Aurora, Colorado 80010, USA. bennett.parnes@uchsc.edu
Main
Deborah S
DS
Dickinson
L Miriam
LM
Niebauer
Linda
L
Holcomb
Sherry
S
Westfall
John M
JM
Pace
Wilson D
WD
D000328:Adult; D003120:Colorado; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D044469:Racial Groups
D006442:Glycated Hemoglobin