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Routine glucometer readings in primary care a 'wasteful practice'

Elimination of routine glucometer readings resulted in cost savings and decreased nursing time with no adverse events, according to research published in JAMA Internal Medicine.

In light of these results, James L. Wofford, MD, MS, from the Department of Internal Medicine at Wake Forest University School of Medicine, and colleagues recommended physicians review their own glucometry practices.

“Estimating blood glucose with a glucometer in patients with diabetes is a standard procedure in most primary care clinical settings,” Wofford and colleagues wrote. “Routinely providing the busy clinician with a glucometer reading seems an efficient way of preparing for informed clinical decision making about diabetic management in the ambulatory setting. However, the routine tasks that are components of rooming the clinic patient are increasing in number.”

The researchers evaluated how valuable routine glucometer readings were at the Downtown Health Plaza Adult Medicine Clinic of Wake Forest Baptist Health, where the physicians have more than 60,000 primary care visits each year. They instituted a policy change that made glucometer readings optional after a 1-week trial resulted in no adverse events.

Wofford and colleagues compared patient care for 3 months before the policy change to 3 months afterward. They reviewed charts from 10 random patients each month; all patients had been previously diagnosed with diabetes and visited the clinic.

The researchers also reviewed other glucometer readings from other patients.

They estimated the policy change resulted in a reduction of glucometer readings from 400 to 100, which equated to an estimated 25 nursing hours saved, as well as cost savings of more than $2,000, based on each glucometer reading requiring $7 and 5 minutes of nursing time.

Wofford and colleagues wrote that physicians in the clinic were initially apprehensive about the policy changing, with “fear of missing an occasional markedly elevated glucose level,” but they adapted and did not consider changing the policy back. They urged health care providers to scrutinize the use of routine tests and their value.

“Challenging the value of routine glucometer readings in the clinic is consistent with recent recommendations to discourage routine home glucometer readings for patients who are not taking insulin, a policy reversal that requires much patient education,” Wofford and colleagues concluded. “As important as the lesson that routine glucometer readings is a wasteful practice, the more important lesson is that examining office routines for foolish consistencies should be a regular component of making primary care more efficient.” – by Chelsea Frajerman Pardes

Disclosure: Wofford, the clinic director, led the staff meeting discussions where the policy decisions were made, initiated the study design and data analysis, and drafted the first version of the manuscript. The other authors were the key participants in the staff meeting discussions after the policy changes were made and both reviewed the final manuscript.