Diabetes screening overhaul could cut GP workload

Using HbA1c to screen for diabetes in pharmacies could identify undiagnosed cases without generating unnecessary GP referrals, researchers believe.

Professor Kamlesh Khunti, professor of primary care diabetes at the University of Leicester and a GP in the city, is leading a study to assess the effectiveness of this approach.

‘We want to reduce the number of people who go to their GP for a test,’ he said.

Patients will be asked to complete a risk assessment in a community pharmacy.

‘On the basis of a high-risk score, half will be asked to see their GP,’ Professor Khunti said. ‘The other half will have a finger-prick test of HbA1c at the pharmacy.’

Those given tests in the pharmacy and found to have elevated HbA1c levels would then be referred to their GP for a second test, he said. Since two elevated HbA1c tests are required for a diagnosis of diabetes, these patients will need just one test at their GP practice.

Patients not found to have elevated HbA1c levels by the pharmacy can be reassured and offered lifestyle advice. This reduces the need for patients to be referred to their GP on the basis of the risk assessment.

Professor Khunti said that previous work on cardiovascular risk screening in pharmacies highlighted the need for such schemes to reduce, rather than increase, GP workload.

‘We found that pharmacists loved it and patients loved it, but that some GPs weren’t so sure, because we had a lot of duplication of work,’ he said. ‘We want a system where there isn’t a lot of duplication.’

As well as avoiding GP appointments, using pharmacies as screening venues offers the potential to reach a broad section of the population.

‘A lot of people go to pharmacies but don’t go to their GP,’ Professor Khunti said.

The 2,000-patient randomised controlled trial has so far recruited about a third of the necessary patients.

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