Prompting Patients with Poorly Controlled Diabetes to Identify Visit Priorities Before Primary Care Visits: a Pragmatic Cluster Randomized Trial.
clinical trials
diabetes
doctor-patient relationships
health information technology
primary care
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
01
04
2018
accepted:
13
11
2018
revised:
20
09
2018
pubmed:
13
2
2019
medline:
21
10
2020
entrez:
13
2
2019
Statut:
ppublish
Résumé
Most patients with diabetes do not meet all evidence-based goals of care, and many patients report poor communication and lack of involvement in decision-making during primary care visits. To test the hypothesis that a "Pre-Visit Prioritization" secure email message could improve visit communication and glycemic control among patients with type 2 diabetes. We conducted a pragmatic, provider-randomized, multi-site clinical trial from March 2015 to October 2016 across 30 primary care practices within Kaiser Permanente Northern California (KPNC), a large integrated care delivery system. Eligible patients had at least 1 year of KPNC membership, type 2 diabetes with most recently measured hemoglobin A1c (HbA1c) > = 8.0%, and were registered users of the KPNC online patient portal. Patients in the intervention arm, upon booking an appointment, received a secure email through the KPNC online portal with a link to the EHR allowing them to submit their top one or two priorities prior to the visit. Control patients received usual care. Glycemic control; change in HbA1c 6 and 12 months after the initial visit; patient-reported outcomes related to patient-provider communication and patient care experiences. During the study period, 1276 patients had at least one eligible visit. In post-visit surveys (n = 457), more intervention arm patients reported preparing questions for their visit (72% vs 63%, p = 0.048) and being given treatment choices to consider (81% vs 73%, p = 0.041). Patients in both arms had similar reductions in HbA1c over the 12-month study period (0.56% ± 1.45%), with no significant differences between arms. A "light touch" email-based pre-visit intervention resulted in improved measures of visit interaction but did not significantly improve glycemic control relative to usual care. Improving diabetes clinical outcomes through more effective primary care visits may require more intensive approaches to patient visit preparation. NCT02375932.
Sections du résumé
BACKGROUND
Most patients with diabetes do not meet all evidence-based goals of care, and many patients report poor communication and lack of involvement in decision-making during primary care visits.
OBJECTIVE
To test the hypothesis that a "Pre-Visit Prioritization" secure email message could improve visit communication and glycemic control among patients with type 2 diabetes.
DESIGN
We conducted a pragmatic, provider-randomized, multi-site clinical trial from March 2015 to October 2016 across 30 primary care practices within Kaiser Permanente Northern California (KPNC), a large integrated care delivery system.
PARTICIPANTS
Eligible patients had at least 1 year of KPNC membership, type 2 diabetes with most recently measured hemoglobin A1c (HbA1c) > = 8.0%, and were registered users of the KPNC online patient portal.
INTERVENTIONS
Patients in the intervention arm, upon booking an appointment, received a secure email through the KPNC online portal with a link to the EHR allowing them to submit their top one or two priorities prior to the visit. Control patients received usual care.
MAIN MEASURES
Glycemic control; change in HbA1c 6 and 12 months after the initial visit; patient-reported outcomes related to patient-provider communication and patient care experiences.
KEY RESULTS
During the study period, 1276 patients had at least one eligible visit. In post-visit surveys (n = 457), more intervention arm patients reported preparing questions for their visit (72% vs 63%, p = 0.048) and being given treatment choices to consider (81% vs 73%, p = 0.041). Patients in both arms had similar reductions in HbA1c over the 12-month study period (0.56% ± 1.45%), with no significant differences between arms.
CONCLUSIONS
A "light touch" email-based pre-visit intervention resulted in improved measures of visit interaction but did not significantly improve glycemic control relative to usual care. Improving diabetes clinical outcomes through more effective primary care visits may require more intensive approaches to patient visit preparation.
TRIAL REGISTRY
NCT02375932.
Identifiants
pubmed: 30746642
doi: 10.1007/s11606-018-4756-4
pii: 10.1007/s11606-018-4756-4
pmc: PMC6544732
doi:
Banques de données
ClinicalTrials.gov
['NCT02375932']
Types de publication
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
831-838Subventions
Organisme : NIDDK NIH HHS
ID : K24 DK109114
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK092924
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK092926
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK099108
Pays : United States
Références
Arch Intern Med. 2012 Aug 13;172(15):1184-6
pubmed: 22777319
Health Serv Res. 2007 Oct;42(5):1871-94
pubmed: 17850524
JAMA. 2003 Sep 24;290(12):1624-32
pubmed: 14506122
Ann Fam Med. 2006 Jan-Feb;4(1):40-5
pubmed: 16449395
J Clin Epidemiol. 2009 May;62(5):464-75
pubmed: 19348971
Diabetes Care. 2015 Jan;38(1):6-8
pubmed: 25538309
Diabetes Educ. 2004 Jan-Feb;30(1):126-35
pubmed: 14999900
BMJ. 2000 May 6;320(7244):1246-50
pubmed: 10797036
J Am Geriatr Soc. 1998 Jul;46(7):889-94
pubmed: 9670878
Health Serv Res. 2003 Dec;38(6 Pt 1):1509-27
pubmed: 14727785
Ann Intern Med. 1985 Apr;102(4):520-8
pubmed: 3977198
Patient Educ Couns. 2014 Jul;96(1):3-12
pubmed: 24795073
N Engl J Med. 2013 Apr 25;368(17):1613-24
pubmed: 23614587
J Gen Intern Med. 1988 Sep-Oct;3(5):448-57
pubmed: 3049968
Diabetes Care. 2012 Jan;35(1):47-9
pubmed: 22100962
Ann Intern Med. 2000 Jan 4;132(1):80-4
pubmed: 10627256
J Gen Intern Med. 2009 Oct;24(10):1135-9
pubmed: 19578818
Curr Diab Rep. 2017 May;17(5):31
pubmed: 28364355
BMJ. 2008 Nov 11;337:a2390
pubmed: 19001484
Cochrane Database Syst Rev. 2012 Dec 12;12:CD003267
pubmed: 23235595
Health Qual Life Outcomes. 2009 Sep 08;7:82
pubmed: 19737412
J Rheumatol. 2007 Jun;34(6):1392-400
pubmed: 17552066
BMC Med Educ. 2008 Jan 14;8:3
pubmed: 18194559
Med Care. 2005 May;43(5):436-44
pubmed: 15838407
Contemp Clin Trials. 2016 Mar;47:196-201
pubmed: 26820612
Milbank Q. 1996;74(4):511-44
pubmed: 8941260
J Gen Intern Med. 1990 Jan-Feb;5(1):29-33
pubmed: 2299426
Healthc (Amst). 2013 Dec;1(3-4):117-122
pubmed: 24944911
Ann Fam Med. 2005 May-Jun;3(3):209-14
pubmed: 15928223
Am J Manag Care. 2005 Apr;11(4):262-70
pubmed: 15839186
J Gen Intern Med. 2002 Apr;17(4):243-52
pubmed: 11972720
J Am Board Fam Med. 2018 Jan-Feb;31(1):29-37
pubmed: 29330237
JAMA. 2017 Nov 14;318(18):1825-1827
pubmed: 29136434
J Gen Intern Med. 2008 Dec;23(12):2058-65
pubmed: 18830762
Ann Intern Med. 2010 Jul 20;153(2):69-75
pubmed: 20643988