Cargando…
Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics
Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiri...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757706/ https://www.ncbi.nlm.nih.gov/pubmed/35048014 http://dx.doi.org/10.3389/froh.2021.670355 |
_version_ | 1784632735494569984 |
---|---|
author | Glurich, Ingrid Berg, Richard Panny, Aloksagar Shimpi, Neel Steinmetz, Annie Nycz, Greg Acharya, Amit |
author_facet | Glurich, Ingrid Berg, Richard Panny, Aloksagar Shimpi, Neel Steinmetz, Annie Nycz, Greg Acharya, Amit |
author_sort | Glurich, Ingrid |
collection | PubMed |
description | Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients. |
format | Online Article Text |
id | pubmed-8757706 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87577062022-01-18 Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics Glurich, Ingrid Berg, Richard Panny, Aloksagar Shimpi, Neel Steinmetz, Annie Nycz, Greg Acharya, Amit Front Oral Health Oral Health Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients. Frontiers Media S.A. 2021-05-26 /pmc/articles/PMC8757706/ /pubmed/35048014 http://dx.doi.org/10.3389/froh.2021.670355 Text en Copyright © 2021 Glurich, Berg, Panny, Shimpi, Steinmetz, Nycz and Acharya. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oral Health Glurich, Ingrid Berg, Richard Panny, Aloksagar Shimpi, Neel Steinmetz, Annie Nycz, Greg Acharya, Amit Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title | Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title_full | Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title_fullStr | Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title_full_unstemmed | Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title_short | Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics |
title_sort | longitudinal observation of outcomes and patient access to integrated care following point-of-care glycemic screening in community health center dental safety net clinics |
topic | Oral Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757706/ https://www.ncbi.nlm.nih.gov/pubmed/35048014 http://dx.doi.org/10.3389/froh.2021.670355 |
work_keys_str_mv | AT glurichingrid longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT bergrichard longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT pannyaloksagar longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT shimpineel longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT steinmetzannie longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT nyczgreg longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics AT acharyaamit longitudinalobservationofoutcomesandpatientaccesstointegratedcarefollowingpointofcareglycemicscreeningincommunityhealthcenterdentalsafetynetclinics |