title: Does availability of expanded point-of-care services improve outcomes for rural diabetic patients?
abstract: OBJECTIVE
  The purpose of this study was to assess compliance with American Diabetes Association screening recommendations at Salina Family Healthcare (SFHC) in Salina, Kansas, a large rural town, and to evaluate the impact of point-of-care (POC) dilated eye exams for uninsured patients. POC exams are those performed in the location where patients are treated.
  
  
  METHODS
  There were 462 type II diabetic (DM2) patients seen at SFHC in 2009 and 537 DM2 patients seen in 2010. A chart review of all patients with DM2 was done to assess rates of recommended screening exams, including dilated eye exams and foot exams.
  
  
  RESULTS
  In 2009/2010 urine microalbumin was checked in 57%/75% of DM2 patients. HbA1c and low density lipoprotein (LDL) levels at goal were 46%/48% and 58%/58%, respectively. 47%/67% of DM@ patients received foot exams and 21%/30% received eye exams. In 2009, 23% of the 155 uninsured diabetic patients at SFHC received a dilated eye exam. The following year, after implementation of on-site ophthalmologic services, rates of dilated eye exams increased 1.6 fold to 37% of the 196 uninsured patients.
  
  
  CONCLUSIONS
  SFHC performed similarly to national rates on some diabetic screening exams, but there is room for improvement in all recommended screening exams. The implementation of a novel approach to increasing dilated eye exam rates indicates that expanded POC services can improve outcomes for diabetic patients.
authors.affiliation: University of Kansas School of Medicine-Salina, Salina, KS, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Brown
authors.forename: Dan
authors.initials: D
authors.lastname: Kuhlman
authors.forename: Lance
authors.initials: L
authors.lastname: Larson
authors.forename: Kara
authors.initials: K
authors.lastname: Sloan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ablah
authors.forename: Kurt
authors.initials: K
authors.lastname: Konda
authors.forename: Christopher Scott
authors.initials: CS
authors.lastname: Owings
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007615:Kansas; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D017057:Medically Uninsured; D008875:Middle Aged; D009184:Mydriatics; D010043:Outcome and Process Assessment, Health Care; D019095:Point-of-Care Systems / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D009184:Mydriatics; C517652:hemoglobin A1c protein, human