Effect of multiple patient reminders in improving diabetic retinopathy screening - A randomized trial
Effect of multiple patient reminders in improving diabetic retinopathy screening - A randomized trial
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DOI：
10.2337/diacare.22.5.752
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发表时间：
1999-05-01
期刊：
影响因子：
16.2
通讯作者：
Legorreta, AP
中科院分区：
文献类型：
--
作者：
Halbert, RJ;Leung, KM;Legorreta, AP
研究设计与方法：1996年8月至1997年7月在加利福尼亚州一家大型网络健康维护组织(HMO)登记的所有大于或等于18岁的糖尿病成员使用索赔和药房数据库进行识别。在HMO的索赔数据库中没有DRE记录的成员随后被随机分为两组。两组都收到了邮寄的教育材料和获得检查的提醒，他们的医生组还收到了一封信，解释了该计划、DRE的当前指南以及他们的糖尿病患者名单和他们的DRE状态。单一干预组没有收到额外的提醒。结果：研究队列包括19523名糖尿病患者，他们被随机分为单一干预组(n=9,614)和多重干预组(n=9,909)。在1996年8月的干预后，两个干预组的每月DRE率都有所增加。在向复合干预组发送第二次提醒后，接受DRE治疗的糖尿病成员比例高于单一干预组。第三次干预前后的比率没有显著差异，也没有发现月度差异。两组的年总DRE率有显著差异(P=0.023)。结论：在管理性医疗环境中，多个患者提醒比单一提醒更有效地提高DRE率，然而，注意到的改善在临床上很小，只有在第二次提醒之后才出现；额外的提醒没有看到递增的改善。用于针对糖尿病视网膜病变的多次提醒的资源可能更好地用于减少糖尿病并发症的其他方法。
OBJECTIVE - To determine whether multiple mailed patient reminders can produce an increase in the rate of diabetic retinal examinations (DRE) over that seen with a single reminder.RESEARCH DESIGN AND METHODS - All diabetic members greater than or equal to 18 years who were enrolled in a large network-based health maintenance organization (HMO) in California from August 1996 to July 1997 were identified using claims and pharmacy databases. Members who had no record of DRE in the HMO's claims database were then randomized into two groups. Both groups received mailed educational materials and a reminder to obtain the examination Their physician groups also received a letter explaining the program, current guidelines for DRE, and a list of their diabetes patients with their DRE status. The single intervention group received no additional reminders. The multiple intervention group received additional reminders at 3, 6, and 9 months after baseline if they continued with no record of service, as determined from the claims database.RESULTS - The study cohort comprised 19,523 diabetic members, which were randomized into single (n = 9,614) and multiple (n = 9,909) intervention groups. There was an increase in monthly DRE rates after the intervention in August 1996 for both intervention groups. After the second reminder was sent to the multiple intervention group, the percentage of diabetic members receiving DRE was higher than the single intervention group. Rates before and after the third intervention were not significantly different, nor were monthly differences found. There was a significant difference in overall annual DRE rates between the groups (P = 0.023).CONCLUSIONS - Multiple patient reminders are more effective than single reminders in improving DRE rates in a managed care setting, However, the improvement noted was clinically small and appeared only after the second reminder; no incremental improvement was seen with additional reminders. Resources used for multiple reminders aimed at diabetic retinopathy might better be spent on other approaches to reducing complications of diabetes.