Similar findings
Commenting on the findings for Medscape Medical News, Joe Parks, MD, vice president and practice improvement and medical director at the National Council for Behavioral Health, Washington, DC, noted that he and his colleagues conducted a similar study in the mid-2000s.
Starting in 2004, they distributed a POC finger prick test device for use by community mental health teams to measure blood glucose and lipid levels.
“We required as a condition of payment that the providers get these lab results for everybody they served and report them centrally. Then, we databased them and benchmarked them, and we were able to show significant reductions in HbA1c’s over time,” said Parks, who was not involved with the current research.
Moreover, that program achieved corresponding savings of $23 to $24 million, he noted.
Although his study and the current study show that POC devices work, he emphasized that it’s not enough to make the devices available to clinicians.
“You also have to ensure the providers put it in their clinic workflows and use it with everybody. To do that, it really helps if you have the providers report the results, then give them report cards so they can see who’s doing it and who isn’t,” Parks said.
It wasn’t surprising that in the current study, the introduction of the POC device made less of an impact in the adult community services, he noted.
Although weight reduction is much slower in that setting, “you can still get better control of their lipids and HbA1c›s, and you get at their weight over time. You just have to program for that, too,» said Parks.
He added that it’s hard to achieve weight reduction of more than 5% or 10%, but many of these patients need a 25% to 30% reduction. “The only thing that’s going to get that is bariatric surgery,” he noted.
POC devices are not widely used in the United States.
“The payer paying for the care basically has to insist that [it] be used and then provide the machine and train the staff to use it,” Parks said.
It requires payers “to get actually involved in how providers organize and manage care, which they tend to not like to do. It’s silly because the only way any payer has to make anybody better is through the provider,” he noted.
Parks added that to increase uptake beyond the “motivated few” requires that it be made part of the workflow and not left up to clinician discretion.
The study was funded by the National Institute for Health Research. Butler and Parks have reported no relevant financial relationships.
A version of this article originally appeared on Medscape.com.