HbA1c testing in the community pharmacy: A new strategy to improve care for patients with diabetes
Notice bibliographique
Résumé
Diabetes is one of the fastest growing diseases in Canada. It is estimated that 2 million Canadians have type 2 diabetes and that there are more than 60,000 new cases of this disease diagnosed each year. The cost of diabetes in Canada is projected to be up to $9 billion annually.1 One-third of those affected with type 2 diabetes are unaware that they have the disease.1 Managing diabetes is a challenging endeavour for those diagnosed and involves routine monitoring and regular testing in order for patients to maintain reasonable glycemic control. The DICE study in 2005 found that 1 in 2 Canadians with type 2 diabetes do not have their blood sugar under control and that control is worse the longer patients have had diabetes.2 As a measure of glycemic control, the Canadian Diabetes Association (CDA) recommends glycated hemoglobin (HbA1c [%]) levels ≤7.0.3 However, according to one study, only 29% of patients with diabetes actually had an HbA1c test in the previous year, and among those tested, only 43% had an HbA1c less than 7%.4 Additionally, 18% of those tested had an HbA1c of 9.5% or more, meaning that their blood glucose levels were uncontrolled.4 Given the complexity of diabetes control, evidence suggests that diabetes can be best managed through an interdisciplinary team that includes a pharmacist.5 The relative accessibility of the community pharmacist allows patients the opportunity to discuss their health care concerns, typically without the need for a referral or appointment (though making an appointment so that the pharmacist is able to set aside an appropriate amount of time is becoming more common). This unique position allows pharmacists to readily monitor patients and assist them in attaining adequate glucose control. HbA1c testing is an important outcome measure in patients with diabetes. Unlike a point-in-time blood glucose measure, the HbA1c provides an estimate of glycemic control over a 3-month period. It allows the health care provider to monitor patients with diabetes and estimate how well their disease is controlled and whether they require additional interventions to maintain target levels. The United Kingdom Prospective Diabetes Study (UKPDS) has shown that lower HbA1c levels have been correlated with fewer complications.6 For instance, in epidemiologic analyses, HbA1c levels >7.0% are associated with a significantly increased risk of both microvascular and macrovascular complications, regardless of underlying treatment.3 John Papastergiou Pharmacy Limited operates at 3 locations as Shoppers Drug Mart in Toronto, Ontario. All 3 pharmacies are located in an urban setting with a diverse, multi-ethnic patient population. The Pharmacy team, including pharmacists, pharmacy technicians, interns and pharmacy students from all 3 locations, is working to improve the management of patients with diabetes through the use of HbA1c testing. Historically, the testing of HbA1c required a visit to the physician and was limited to a laboratory blood test. With the introduction of the Bayer A1C Now meters, patients can be tested by their community pharmacist without a laboratory requisition and HbA1c results can be made available within 5 minutes. The HbA1c meter has demonstrated an accuracy of 99% in 3 independent evaluation studies.7 The Pharmacy team decided that the level of accuracy, in combination with the ease and speed of testing, made this new innovation the perfect tool for testing and monitoring their patients with diabetes. The meters provide an efficient and reliable method for HbA1c monitoring. The HbA1c result provides the pharmacist with more information regarding the patient's glycemic control and allows for additional consultation and recommendations in an attempt to improve outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,033 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,005 | 0,002 |
| Communication savante | 0,009 | 0,013 |
| Science ouverte | 0,006 | 0,011 |
| Intégrité de la recherche | 0,009 | 0,015 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,038 | 0,012 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».