Improving Diabetes Care Among Patients Overdue for Recommended Testing: A Randomized Controlled Trial of Automated Telephone Outreach

Abstract

OBJECTIVEThe study's objective was to assess the effects of automated telephone outreach with speech recognition (ATO-SR) on diabetes-related testing.RESEARCH DESIGN AND METHODSWe identified 1,200 health plan members who were overdue for diabetes-related testing and randomly allocated 600 to ATO-SR and 600 to usual care (no intervention). The intervention included three interactive calls encouraging recommended testing. The primary outcome was retinopathy testing, since this was the health plan's principal goal. Tests for glycemia, hyperlipidemia, and nephropathy were secondary outcomes.RESULTSIn total, 232 participants (39%) verbally responded to the calls. There was no difference between the intervention and the usual care groups in the primary outcome (adjusted hazard ratio 0.93 [95% CI 0.71–1.22]) and no effect of the intervention on any of the secondary outcomes.CONCLUSIONSFewer than 40% of the patients randomized to ATO-SR interacted verbally with the system. The intervention had no effect on the study's outcomes.

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

“…The included studies were conducted between 1988 and 2013. Thirty-five studies (53%) were parallel-group patient RCTs enrolling 237,025 patients 59,[61][62][63]71,72,75,80,82,[85][86][87][88][89]95,96,98,99,102,103,[107][108][109][111][112][113][114][115][116][117][118][119][120][121][122] and 31 (47%) were cluster RCTs in which the HCP or the health-care setting was the unit of randomisation. 58,60,64-70, 73,74,76-79,81,83,84,90-94,97,100,101,104-106,110,123 These included 6126 clusters (range 6-4125 clusters).…”

“…Care guide workstations were located in the clinic waiting rooms, to facilitate face-to-face interactions with patients, providers, and nurses Adair et al 59 We explored publication bias using a funnel plot for the main comparison of any intervention with usual care (56 studies [58][59][60][61][62][63][65][66][67][68][69][70][71][72][74][75][76][77][78][80][81][82][83][84][85][86][87][88][89][92][93][94][95][96][97][98][99][100][101][102][103][104][105][108][109][110][111][112]…”

Personal health technology: A new era in cardiovascular disease prevention

“…63 A trial of IVR use to promote diabetes-related retinopathy testing among 1,200 health plan members showed low uptake of the intervention and no improvement in testing rates relative to randomized controls. 73 Finally, a US trial of IVR augmentation to a successful peer-support model for promoting care management among Spanish-speakers with diabetes found no incremental benefit of the IVR booster intervention. 64 …”

The Impact of Comprehensive Pre-visit Preparation on Patient Engagement and Quality of Care in a Population of Underserved Patients with Diabetes: Evidence from the Care Management Medical Home Center Model

“…21,22,23 A study of an automated telephone call system used specifically to remind patients with diabetes about retinopathy, microalbumin, and HbA1c testing failed to increase compliance with these tests. 24 Distinct from the majority of telephone-based interventions that focus on 1 outcome, often visit attendance or referral completion, the CMMHC's pre-office visit phone call is comprehensive. In addition to reminding patients of their upcoming appointment, the centralized care team gathers information on health status, adherence to self-care goals, and recent emergency room visits and hospital admissions.…”