Automated messaging to improve compliance with diabetes test monitoring.

OBJECTIVES: To evaluate the use of automated systems to prompt patients with diabetes mellitus to obtain overdue laboratory tests for its effectiveness in promoting test compliance and to compare letters, telephone messages, and combinations. STUDY DESIGN: Randomized controlled trial. METHODS: All subjects (N = 13,057) were adult members of Southern California Kaiser Permanente with diabetes and with no record of glycosylated hemoglobin, low-density lipoprotein cholesterol, and urinary microalbumin tests in more than 1 year. The effectiveness of automated telephone calls and letters was compared versus a no-contact control group using the following 5 intervention groups: letter, call, letter that is followed by a call 4 weeks later, call that is followed by a letter 4 weeks later, and letter-call-letter combination. Messages were in English and in Spanish. Adherence to all testing was compared at 8 weeks and 12 weeks after initial contact using chi(2) test and logistic regression analysis. RESULTS: The proportions of each study group compliant with all tests were 18% to 19% among controls, 21% for a letter or a call, 25% for a letter-call or call-letter, and 26% for a letter-call-letter; letter-call and call-letter were significantly different versus controls (P <.001), and letter-call-letter was not significantly different versus letter-call. Older age was associated with compliance (P <.001). CONCLUSIONS: The pairing of automated letters and telephone calls in any order was more effective than any single intervention in promoting compliance with diabetes monitoring tests. The relative cost of the letter-call and call-letter approaches to outreach should be considered to determine which is preferred in any given situation.

Point-of-Service reminders for prescribing cardiovascular medications.

OBJECTIVES: To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent cardiovascular events. STUDY DESIGN: Randomized controlled trial. METHODS: Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were faxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups. RESULTS: More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were dispensed in 7.1% of visits in the intervention group versus 5.7% in the control group (P = .048) following the first patient-physician encounter. No significant difference was observed for statins (intervention, 8.1% vs control, 7.7%). Data for all patient-physician encounters and both medications were combined in logistic regression analysis. The odds ratio was 1.19 for a dispensed prescription in the intervention group and 1.54 for 2 or more visits versus 1 visit. CONCLUSIONS: An automated system that provides pertinent data and tailored recommendations for care at the point of service modestly increased prescription dispensing rates. Targeting patient-provider encounters to change provider behavior is challenging; however, even small effects can produce clinically important results over time.