- Email: [email protected]
A Proactive Community Laboratory and the Management of Diabetes
Clinical Biochemistry 38 (2005) 956 – 957
Letter to the Editor A Proactive Community Laboratory and the Management of Diabetes To the editor: In the March 2005 issue of Clinical Biochemistry, Dr. A. Theriault, in reviewing the text bDiabetes and Laboratory MedicineQ (Author: Janet Smith, Publisher: ACB Venture Publications, ISBN 0902429310) commented: bTherefore, the time has come for the laboratory to become proactive in helping physicians diagnose and manage diabetes. . .Q A pilot project initiated and managed by Valley Medical Laboratories in Kelowna, British Columbia, Canada would seem to fill the need perceived by Dr. Theriault, in that the laboratory, with the agreement of patients’ physicians, organizes the testing of diabetics according to the Canadian Diabetes Association guidelines. The project began operation in January 2002. It utilizes the administrative structure of a community medical laboratory to: ! identify people who appear to have diabetes; ! create a registry of diabetics; ! provide appointments for testing dates, and, if necessary, follow-up reminders; ! provide special reports for physicians; ! provide special reports for selected participating diabetics. This is a management tool, not a research project. It is seen to assist busy family physicians in the care of their diabetic patients, and perhaps more importantly, provides laboratory results (with targets and explanations) directly to patients. Ninety-six percent (96%) of family physicians in the area where the project is offered participate in it. The estimated prevalence of diabetes in the area of interest is 7500, based on 5% of a population of 150,000. By April 30, 2005, a total of 5903 diabetics have been identified, of whom 3783 participate in the project (are active participants), whilst 1433 are registered but excluded for various reasons (advanced age, terminal illness, lack of patient interest, etc.), and 687 are awaiting registration. Patients are only registered in the project at the request of a family physician, and the registration process includes
processing a set of individualized standing orders, thus fulfilling billing requirements of the BC Medical Services Plan. The recommended test schedule follows the 2003 Canadian Diabetes Association guidelines, and includes a laboratory determination of blood pressure at each visit. Physicians need not follow the CDA guidelines and can specify any frequency of testing. In addition to regular laboratory reports, physicians receive: ! an annual summary of all registered patients, with registration categories, and ! semi-annual lists of potential new participants as determined by results of blood sugars or A1C test results on subjects tested in the previous 6 months. Patients of those physicians that serve as an advisory group to the project receive their own results by mail within 2 weeks of a new A1C test. The patient reports include the most recent A1C, systolic blood pressure, LDL cholesterol, and risk ratio, as well as information about the test items, target levels, and advice on the importance of regular eye examinations. Statistics from the BC Ministry of Health show that approximately only 40% of known diabetics in British Columbia have two or more A1C tests annually. In contrast, 80% of participants in our project had two or more A1Cs in 2004. A1C and LDL cholesterol results have shown improving trends over time for both participants and non-participants, but the trend is particularly evident for participants, as illustrated in Table 1. We agree completely with Dr. Theriault’s contention that the time has come for the medical laboratory to become proactive in assisting patients and physicians in the management of diabetes. Table 1 Valley medical laboratories Kelowna diabetes project A1C and LDL results percentage of participants and non-participants by year and results Year (%) A1C LDL
b7 N8 b2.5 N3.5
0009-9120/$ - see front matter D 2005 Published by The Canadian Society of Clinical Chemists. doi:10.1016/j.clinbiochem.2005.07.007
Participants
Non-participants
2002 (%)
2004 (%)
2002 (%)
2004 (%)
53 19 33 23
65 11 49 16
54 21 35 25
57 16 38 22
Letter to the Editor
Duncan Innes David Cameron* Valley Medical Laboratories, 105-537 Leon Avenue, Kelowna BC, V1Y 6J5, USA E-mail address: [email protected]. *Corresponding author. Fax: +1 250 862 2843. 23 June 2005
957
Letter to the Editor A Proactive Community Laboratory and the Management of Diabetes To the editor: In the March 2005 issue of Clinical Biochemistry, Dr. A. Theriault, in reviewing the text bDiabetes and Laboratory MedicineQ (Author: Janet Smith, Publisher: ACB Venture Publications, ISBN 0902429310) commented: bTherefore, the time has come for the laboratory to become proactive in helping physicians diagnose and manage diabetes. . .Q A pilot project initiated and managed by Valley Medical Laboratories in Kelowna, British Columbia, Canada would seem to fill the need perceived by Dr. Theriault, in that the laboratory, with the agreement of patients’ physicians, organizes the testing of diabetics according to the Canadian Diabetes Association guidelines. The project began operation in January 2002. It utilizes the administrative structure of a community medical laboratory to: ! identify people who appear to have diabetes; ! create a registry of diabetics; ! provide appointments for testing dates, and, if necessary, follow-up reminders; ! provide special reports for physicians; ! provide special reports for selected participating diabetics. This is a management tool, not a research project. It is seen to assist busy family physicians in the care of their diabetic patients, and perhaps more importantly, provides laboratory results (with targets and explanations) directly to patients. Ninety-six percent (96%) of family physicians in the area where the project is offered participate in it. The estimated prevalence of diabetes in the area of interest is 7500, based on 5% of a population of 150,000. By April 30, 2005, a total of 5903 diabetics have been identified, of whom 3783 participate in the project (are active participants), whilst 1433 are registered but excluded for various reasons (advanced age, terminal illness, lack of patient interest, etc.), and 687 are awaiting registration. Patients are only registered in the project at the request of a family physician, and the registration process includes
processing a set of individualized standing orders, thus fulfilling billing requirements of the BC Medical Services Plan. The recommended test schedule follows the 2003 Canadian Diabetes Association guidelines, and includes a laboratory determination of blood pressure at each visit. Physicians need not follow the CDA guidelines and can specify any frequency of testing. In addition to regular laboratory reports, physicians receive: ! an annual summary of all registered patients, with registration categories, and ! semi-annual lists of potential new participants as determined by results of blood sugars or A1C test results on subjects tested in the previous 6 months. Patients of those physicians that serve as an advisory group to the project receive their own results by mail within 2 weeks of a new A1C test. The patient reports include the most recent A1C, systolic blood pressure, LDL cholesterol, and risk ratio, as well as information about the test items, target levels, and advice on the importance of regular eye examinations. Statistics from the BC Ministry of Health show that approximately only 40% of known diabetics in British Columbia have two or more A1C tests annually. In contrast, 80% of participants in our project had two or more A1Cs in 2004. A1C and LDL cholesterol results have shown improving trends over time for both participants and non-participants, but the trend is particularly evident for participants, as illustrated in Table 1. We agree completely with Dr. Theriault’s contention that the time has come for the medical laboratory to become proactive in assisting patients and physicians in the management of diabetes. Table 1 Valley medical laboratories Kelowna diabetes project A1C and LDL results percentage of participants and non-participants by year and results Year (%) A1C LDL
b7 N8 b2.5 N3.5
0009-9120/$ - see front matter D 2005 Published by The Canadian Society of Clinical Chemists. doi:10.1016/j.clinbiochem.2005.07.007
Participants
Non-participants
2002 (%)
2004 (%)
2002 (%)
2004 (%)
53 19 33 23
65 11 49 16
54 21 35 25
57 16 38 22
Letter to the Editor
Duncan Innes David Cameron* Valley Medical Laboratories, 105-537 Leon Avenue, Kelowna BC, V1Y 6J5, USA E-mail address: [email protected]. *Corresponding author. Fax: +1 250 862 2843. 23 June 2005
957