The impact of interventions on appointment and clinical outcomes for individuals with diabetes: a systematic review

Abstract

BackgroundSuccessful diabetes disease management involves routine medical care with individualized patient goals, self-management education and on-going support to reduce complications. Without interventions that facilitate patient scheduling, improve attendance to provider appointments and provide patient information to provider and care team, preventive services cannot begin. This review examines interventions based upon three focus areas: 1) scheduling the patient with their provider; 2) getting the patient to their appointment, and; 3) having patient information integral to their diabetes care available to the provider. This study identifies interventions that improve appointment management and preparation as well as patient clinical and behavioral outcomes.MethodsA systematic review of the literature was performed using MEDLINE, CINAHL and the Cochrane library. Only articles in English and peer-reviewed articles were chosen. A total of 77 articles were identified that matched the three focus areas of the literature review: 1) on the schedule, 2) to the visit, and 3) patient information. These focus areas were utilized to analyze the literature to determine intervention trends and identify those with improved diabetes clinical and behavioral outcomes.ResultsThe articles included in this review were published between 1987 and 2013, with 46 of them published after 2006. Forty-two studies considered only Type 2 diabetes, 4 studies considered only Type 1 diabetes, 15 studies considered both Type 1 and Type 2 diabetes, and 16 studies did not mention the diabetes type. Thirty-five of the 77 studies in the review were randomized controlled studies. Interventions that facilitated scheduling patients involved phone reminders, letter reminders, scheduling when necessary while monitoring patients, and open access scheduling. Interventions used to improve attendance were letter reminders, phone reminders, short message service (SMS) reminders, and financial incentives. Interventions that enabled routine exchange of patient information included web-based programs, phone calls, SMS, mail reminders, decision support systems linked to evidence-based treatment guidelines, registries integrated with electronic medical records, and patient health records.ConclusionsThe literature review showed that simple phone and letter reminders for scheduling or prompting of the date and time of an appointment to more complex web-based multidisciplinary programs with patient self-management can have a positive impact on clinical and behavioral outcomes for diabetes patients. Multifaceted interventions aimed at appointment management and preparation during various phases of the medical outpatient care process improves diabetes disease management.

Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: a cluster randomized trial

“…Studies show that metabolic control of diabetes is the result of self-care in the user, in that the individual is able to manage their daily control with behavior changes based on healthy lifestyle habits. They also show that the use of protocols to guide educational practices in a co-responsible manner maximizes the program's activities in developing self-care [5, 10, 34]. …”

Organization of Diabetes Care

“…Clinical information systems (CIS) that allow for a populationbased approach to diabetes assessment and management, such as electronic health (medical) records (EMRs) and electronic patient registries, have been shown to have a positive impact on evidencebased diabetes care (17,29,(74)(75)(76)(77)(78). Practice-level clinical registries give an overview of an entire practice, which may assist in the delivery and monitoring of patient care.…”

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial (Preprint)

“…In contrast, an Australian study [48] used text message reminders to improve hepatitis B vaccination among high-risk sexual health center attendees and found that it was not an effective intervention. A literature review examining the effect of SMS and e-mails to improve diabetes management showed that simple phone call, letter or SMS reminders can have a positive impact on clinical and behavioral outcomes [49]. A systematic review [50] indicated that text messaging interventions improved patients' medication adherence rate.…”