Timings for HbA(1c) testing in people with diabetes are associated with incentive payments: an analysis of UK primary care data

AIMS: Guidelines recommend testing HbA(1c) every 3–6 months in people with diabetes. In the United Kingdom (UK), primary care clinics are financially incentivized to monitor HbA(1c) at least annually and report proportions of patients meeting targets on 31 March. We explored the hypothesis that this reporting deadline may be associated with over‐frequent or delayed HbA(1c) testing. METHODS: This analysis used HbA(1c) results from 100 000 people with diabetes during 2005–2014 in the Clinical Practice Research Datalink UK primary care database. Logistic regression was used to explore whether the four months prior to the deadline for quality reporting (December to March) or individual's previous HbA(1c) were aligned with retesting HbA(1c) within 60 days or > 1 year from the previous test, and identify other factors associated with the timing of HbA(1c) testing. RESULTS: Retesting HbA(1c) within 60 days or > 1 year was more common in December to March compared with other months of the year (odds ratio 1.06, 95% confidence interval 1.04–1.08 for retesting within 60 days). Those with higher HbA(1c) were more likely to have a repeat test within 60 days and less likely to have a repeat test > 1 year from the previous test. CONCLUSIONS: We have found that retesting HbA(1c) within 60 days and > 1 year from the previous test was more common in December to March compared with the other months of the year. This work suggests that both practice‐centred administrative factors and patient‐centred considerations may be influencing diabetes care in the UK.