La distance entre domicile du patient et laboratoire influence-t-elle le suivi biologique du diabète ?

Abstract

Objective: Laboratory tests play an important role in general practice. Access to a clinical laboratory is essential and can potentially influence whether or not these tests are performed. This study assessed the impact of the distance between the patient’s home and the clinical pathology laboratory on laboratory monitoring of diabetes. Methods: This was a retrospective observational study conducted over a period of 3 years on a cohort of diabetic patients from 11 clinical pathology laboratories in the Saint-Etienne region. The primary endpoint was at least three HbA1c, one serum creatinine, one lipid profile and one microalbuminuria over a 12-month period. Statistical analysis was based on the following variables: distance between the patient’s home and the clinical pathology laboratory, patient’s age, their health insurance, type of urban area and the site of blood sampling. Results: Among the 12,773 subjects included, 1,889 (14.8%) complied with the monitoring procedure. The successful monitoring rate decreased by 38% when the distance from the laboratory was more than 5 km (OR 1.38 [1.18 to 1.61]). Monitoring compliance increased with age (OR 0.71 [0.61 to 0.83] for subjects 55-65 years old and 0.61 [0.53 to 0.71] for subjects over 65 years old). However, patients in rural areas and in urban areas with less than 10,000 inhabitants presented better compliance with monitoring than patients living in towns with more than 200,000 inhabitants. Conclusions: Compliance with laboratory monitoring decreased as the distance between the patient’s home and the clinical pathology laboratory increased. These results raise the question of the possible role of home sampling and the availability of other relevant tests required for general practice.