Browsing by Author "Hanson, Courtney"

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    Comparison of 3 risk factor-based screening tools for the identification of prediabetes
    (Elsevier, 2020) Gamston, Courtney E.; Kirby, Anna N.; Hansen, Richard A.; Redden, David T.; Whitley, Heather P.; Hanson, Courtney; Lloyd, Kimberly B.; Auburn University; University of Alabama System; University of Alabama Tuscaloosa
    Objective: To compare risk factor-based screening tools for identifying prediabetes. Methods: Participants in an employer-based wellness program were tested for glycosylated hemoglobin (A1C) at a regularly scheduled appointment, and prediabetes risk factor information was collected. The likelihood of having prediabetes and the need for laboratory testing were determined based on 3 risk factor-based screening tools: the Prediabetes Screening Test (PST), Prediabetes Risk Test (PRT), and 2016 American Diabetes Association guidelines (ADA2016). The results from the screening tools were compared with those of the A1C test. The predictive ability of the PST, PRT, and ADA2016 were compared using logistic regression. Results were validated with data from a secondary population. Results: Of the 3 risk factor-based tools examined, the PRT demonstrated the best combination of sensitivity and specificity for identifying prediabetes. From July 2016 to March 2017, 740 beneficiaries of an employer-sponsored wellness program had their A1C tested and provided risk factor information. The population prevalence of prediabetes was 9.3%. Analysis of a second independent population with a prediabetes prevalence of more than 50% of confirmed PRT's superiority despite differences in the calculated sensitivity and specificity for each population. Conclusion: Because PRT predicts prediabetes better than PST or ADA2016, it should be used preferentially. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.
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    Description of a pharmacist-led diabetes prevention service within an employer-based wellness program
    (Elsevier, 2019) Gamston, Courtney E.; Kirby, Anna N.; Hansen, Richard A.; Redden, David T.; Whitley, Heather P.; Hanson, Courtney; Lloyd, Kimberly B.; Auburn University; University of Alabama Birmingham; University of Alabama Tuscaloosa
    Objectives: To describe a pharmacist-led diabetes prevention service piloted within an employer-based wellness program. Practice description: A pharmacist-led ambulatory care clinic within a school of pharmacy that provides wellness services to university employees. Practice innovation: Implementation of a diabetes prevention service using opportunistic AIC screening within a biometric screening program. Patients with a prediabetes-level A1C from July 2016 to March 2019 were invited to participate in the National Diabetes Prevention Program (NDPP). Evaluation: Comparison of baseline characteristics of participants with normal and elevated A1C. Evaluation of participation in the NDPP and changes in clinical values at the subsequent biometric screening appointment for individuals with a prediabetes-level A1C. Results: A1C testing of 740 individuals identified 69 participants (9.3%) with a prediabetes-level A1C and 7 (1.0%) with a diabetes-level A1C. Compared with those with a normal A1C (< 5.7%), participants with an elevated A1C were more likely to be older, nonwhite, obese, and physically inactive, to have a sibling with diabetes, higher random blood sugar (RBS), lower high-density lipoprotein (HDL), and more likely to have hypertension. Twelve patients participated in the NDPP, although most attended only 1 session. Attenders had a significantly lower baseline weight and body mass index (BMI). There were no significant differences in the changes in A1C, BMI, weight, RBS, or HDL between attenders and nonattenders approximately 1 year later. Conclusion: This pilot demonstrated that opportunistic A1C testing could be incorporated into an ambulatory care clinic within a pharmacist-led employer-based wellness program. Uptake and retention of the NDPP were poor. Barriers to NDPP participation need to be investigated and addressed to improve service impact. (C) 2019 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.
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    Rationale of family medicine physicians in effectively identifying patients with chronic hyperglycemia through point-of-care hemoglobin A1C screenings
    (Springer, 2019) Whitley, Heather P.; Hanson, Courtney; Parton, Jason M.; Smith, Warren D.; Auburn University; University of Alabama Tuscaloosa
    PurposeMany patients are unknowingly living with chronic hyperglycemia, possibly due to low screening rates. We aimed to correlate detection of unidentified chronic hyperglycemia to practitioner reported rationale for conducting diabetes screening.MethodsPhysicians screened patients via a point-of-care A1C tests and recorded corresponding rationales. Elevated outcomes (A1C5.7%) were correlated to recorded rationales, frequency of repeat screenings, documented diagnoses, and therapeutic actions taken as a result of elevated A1C.ResultsNearly one-half (45%) of selected patients were unknowingly living with chronic hyperglycemia, having an average A1C of 7.92% for outcomes 6.5%. Most commonly recorded rationales were overweight status (71%), high-risk ethnicity (58%), and age>45years (48%); previously recorded A1C result of 5.7% ((2) 16.02, p<0.001) and hypertension diagnosis ((2) 10.37, p=0.0013) showed statistically significant correlation with elevated A1C outcomes. A1C results 6.5% versus 5.7-6.5% more frequently prompted repeat screenings (77% vs 20%), ICD-10 code documentation (91% vs 28%), lifestyle modification recommendations (78% vs 35%), and drug therapy initiation (78% vs 9%).ConclusionsReported rationales were largely impacted by visual inspections of age, race, and weight, and prediabetic A1C values garnered less attention compared to higher values. Utilization of POC A1C screening followed by conformational repeat testing is a practical approach to improve diagnostic rates and initiation of care for diabetes.
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    Systematic Diabetes Screening Using Point-of-Care HbA(1c) Testing Facilitates Identification of Prediabetes
    (Annals of Family Medicine, 2017) Whitley, Heather P.; Hanson, Courtney; Parton, Jason M.; Auburn University; University of Alabama Tuscaloosa
    This prospective longitudinal study compares diabetes screenings between standard practices vs systematically offered point-of-care (POC) hemoglobin A1c (HbA1c) tests in patients aged 45 years or older. Systematically screened participants (n = 164) identified 63% (n = 104) with unknown hyperglycemia and 53% (n = 88) in prediabetes. The standard practice (n = 324) screened 22% (n = 73), most commonly by blood glucose (96%); 8% (n = 6) and 33% (n = 24) were found to have diabetes and prediabetes, respectively. The association between screening outcome and screening method was statistically significant (P = 0.005) in favor of HbA(1C). HbA(1c) may be the most effective method to identify patients unknowingly living in hyperglycemia. Point-of-care tests further facilitate screening evaluation in a timely and feasible fashion.