Impact of Order Restrictions on Hemoglobin A1c Requests at Primary Health Care Centers in Riyadh, Saudi Arabia.

IF 2.7 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Risk Management and Healthcare Policy Pub Date : 2025-01-11 eCollection Date: 2025-01-01 DOI:10.2147/RMHP.S499918

Maha Alakeely, Nazish Masud, Fatemah Bin Saleh, Razan Alghassab, Nouf AlFagih, Moath Abdulmohsen Alkathiri, Sarrah Albakri

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引用次数: 0

Abstract

Purpose: The aim of the study was to assess the effect of policy intervention on the physician ordering of HbA1c for the patients seen at the primary health care center in Riyadh, Saudi Arabia.

Methods: The study included patients over the age of 18 for whom HbA1c tests were ordered before and after the policy restrictions were implemented at the three main Primary Health Care Centers under the Ministry of National Guard Health Affairs (MNGHA) in Riyadh, between October 2020 and August 2023. Several data management steps and restrictions were carried out to identify the patients seen before and after the intervention and controlled for the confounders. The outcome variable was inappropriate testing, and early testing was defined based on standard cutoffs of HbA1c, diabetic control, and patient history. The logistic regression analysis was used to identify predictors for early testing.

Results: Among 16,290 participants, the mean age was 50 ± 16 years, with a predominance of females (66.5%). Approximately 22.3% of participants were diabetic, and the mean HbA1c level was 6.2 ± 1.55%. About 89.6% of tests were deemed inappropriate based on criteria for glycemic control, diabetic status, and duration of testing. Policy restrictions led to a 70.3% reduction in the odds of early testing (OR = 0.297, 95% CI: 0.246-0.358, p < 0.001). Each unit increase in HbA1c decreased the odds of early testing by 1.517 (OR = 0.219, 95% CI: 0.193-0.249, p < 0.001). Additionally, younger participants were more likely to undergo early testing, with odds decreasing by 3% for each additional year of age (OR = 0.970, 95% CI: 0.966-0.974, p < 0.001).

Conclusion: We conclude that policy restriction alone might not be effective in reducing the burden of early testing. The early testing tendency was less in the post-intervention period. However, early testing was a common practice in both pre- and post-intervention phases. As physicians are the ones ordering the tests, deeper insight is needed from the physician's perspective.

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沙特阿拉伯利雅得初级卫生保健中心命令限制对血红蛋白A1c请求的影响

目的：本研究的目的是评估政策干预对在沙特阿拉伯利雅得初级卫生保健中心就诊的患者的糖化血红蛋白医嘱的影响。方法：该研究纳入了在2020年10月至2023年8月期间，在利雅得国民警卫队卫生事务部（MNGHA）下属的三个主要初级卫生保健中心实施政策限制前后订购了HbA1c检测的18岁以上患者。进行了一些数据管理步骤和限制，以确定干预前后见过的患者，并控制混杂因素。结果变量是不适当的检测，早期检测是根据HbA1c、糖尿病控制和患者病史的标准临界值来定义的。使用逻辑回归分析来确定早期检测的预测因子。结果：16290名参与者平均年龄50±16岁，以女性居多（66.5%）。大约22.3%的参与者患有糖尿病，平均HbA1c水平为6.2±1.55%。根据血糖控制、糖尿病状态和检测时间的标准，约89.6%的检测被认为是不适当的。政策限制导致早期检测的几率降低70.3% （OR = 0.297, 95% CI: 0.246-0.358, p < 0.001）。HbA1c每增加一个单位，早期检测的几率降低1.517 （OR = 0.219, 95% CI: 0.193-0.249, p < 0.001）。此外，年轻的参与者更有可能接受早期检测，每增加一岁，赔率降低3% （OR = 0.970, 95% CI: 0.966-0.974, p < 0.001）。结论：仅靠政策限制可能无法有效减轻早期检测的负担。干预后早期检测倾向较低。然而，在干预前和干预后阶段，早期检测是一种常见的做法。由于医生是安排检查的人，因此需要从医生的角度进行更深入的了解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Risk Management and Healthcare Policy Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.20

自引率

2.90%

发文量

242

审稿时长

16 weeks

期刊介绍： Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include: Public and community health Policy and law Preventative and predictive healthcare Risk and hazard management Epidemiology, detection and screening Lifestyle and diet modification Vaccination and disease transmission/modification programs Health and safety and occupational health Healthcare services provision Health literacy and education Advertising and promotion of health issues Health economic evaluations and resource management Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.