Observational assessment of the utilization of donated point of care tests and glycemic control at free and charitable clinics across the United States

Abstract

Introduction: Populations experiencing poverty often lack access to convenient lab tests. This analysis assesses trends observed from a national point of care (POC) lab donation program for free and charitable clinics across the United States.

Methods: A total of 16 clinics were selected to receive a comprehensive package of POC lab tests. De-identified data on POC test utilization and results were assessed to descriptively identify trends in utilization (primary objective) and glycemic control (secondary objective). A paired t-test was utilized to identify statistically significant changes in HbA1c from baseline to predefined 90-day time intervals for all people living with diabetes (PLWD) and those with a baseline HbA1c ≥ 9.0 % (75 mmol/mol). The main comparison of interest was the change in HbA1c from baseline to 90-179 days.

Results: A total of 17,563 POC tests were completed for 9658 patients with 3223 tests being HbA1c's. In the secondary analysis of PLWD with a baseline HbA1c ≥ 9.0 % (75 mmol/mol), patients who completed an HbA1c between 90 and 179 days (n = 188) demonstrated a statistically significant mean reduction from baseline of -1.2 % (95 % CI, -1.6 % to -0.9 %, p < 0.01, -10 mmol/mol [95 % CI, -6 mmol/mol - -14 mmol/mol]).

Discussion: The provision of POC labs helped support the care populations experiencing poverty received at free and charitable clinics, especially for chronic diseases like diabetes.

Keywords: Diabetes; Free and charitable clinics; HbA1c; Philanthropy; Point of care labs.

Graphical abstract

Fig. 1

Heart to Heart International Point of Care (POC) lab test donation sites per state since inception in 2016 (A) and Recent Sites Included in this Analysis (B)(the numbers in each state represent the number of implementation sites per state).

Fig. 2

Utilization of different point of care tests by type (A) and variability by clinic (B). (each bar in graph B illustrates the consumption of each test by each of the 16 different partner clinics) HbA1c-glycosylated hemoglobin, HIV-Human immunodeficiency virus, Hep C – hepatitis C, Strep A – Group A Streptococcus, Flu A/B – Influenza type A/B, RSV-respiratory syncytial virus, PT/INR – prothrombin time/international normalized ratio, COVID – coronavirus disease.

Fig. 3

– Summary of utilization of HbA1c.

Fig. 4

– HbA1c Trends for Patients with a Baseline HbA1c ≥ 9.0 % (75 mmol/mol) and subsequent follow-up results ∗p < 0.01 via paired t-test.