Community pharmacy-based A1c screening: a Canadian model for diabetes care

Objectives Point-of-care HbA1c screening devices are a valuable tool that community pharmacists can use to monitor patients with diabetes and improve their overall management. We previously reported our experiences using these devices to assess glycaemic control in diabetic patients at three community pharmacy locations in Toronto, Ontario. Here, we report data from screening of over 1000 patients at clinics held across Canada. Methods Community pharmacies across Canada offering A1c screening as part of their professional programmes were invited to upload screening data to a central database. A1c analysis was performed using the Bayer A1c Now. Patient recruitment and approach to A1c screening were at the discretion of the participating pharmacies and were not standardized. Data collection took place over a period of 8 months. Key findings The majority of patients screened (59.1%) had A1c values above target, indicating inadequate glycaemic control. Glycaemic control was generally poorer among patients on more intensive treatment regimens. A total of 1711 clinical interventions were performed by pharmacists. An average of two interventions were performed per patient, and we observed a trend towards increased numbers of interventions in patients with poorer glycaemic control. The prevalence of specific types of interventions showed an apparent shift from predominantly pharmacist-directed interventions in patients with better glycaemic control towards an increased prevalence of physician-directed interventions in patients with poorer glycaemic control. Conclusions These results illustrate the prevalence of suboptimal glycaemic control among diabetic patients in the community, which represents a significant opportunity for pharmacists to use point-of-care screening to detect hyperglycaemia and intervene to improve disease management when warranted.