On a mission to combat health disparities in America
Follow-up on Patients with Uncontrolled Diabetes
An investigation of the effect of post appointment phone call follow- up on patients with uncontrolled Diabetes Mellitus Type II and their hemoglobin A1C’sContributors:
Aleksandra Kardasheva, Wesley Jones, Dan Krause, Janet Blasko, Patrick Xu, Inyoung Na, Thuy-Ngan Nguyen, Annie Le, Angela Park, Eric Lee, Dr. Parsons, Dr. Michaelis, Dr. Lewis
HealthPoint Community Health Clinics
Diabetic patients are a huge population at our clinics. They are difficult to manage due to many factors: homelessness, poverty, education, access to nutritional foods, transportation. The purpose of this study was to investigate how a motivational follow-up phone call can help high-risk diabetic patients meet their hemoglobin A1c goal.
The inclusion criteria for the study population were patients with a hemoglobin A1c ≥ 9 and a future appointment 3-4 months from their A1c check. The study population was identified by compiling a list of diabetic patients with an appointment within a given timeframe and narrowed by their last A1c. The experimental group was given a call 4 weeks prior to their appointment, while the control group was not. The patients were asked about diabetes management and encouraged to follow their plan. The change in A1c was compared between the two groups to see the effect of the intervention.
Principal Findings and Quantitative/Qualitative Results
We identified 75 adult patients with a Hg A1c ≥ 9. Of these, 48 had a follow-up appointment within the next 3 months. 16 had an appointment within 2 weeks (controls) and 12 had an appointment in 4 weeks. The experimental and control group had an average change in A1c of +0.02 and +0.3, respectively. Our statistical analysis was limited by the small sample size of 28. The p-value was calculated to be 0.935. However, patients were touched by our interest in their health and diabetes status. Patients expressed their gratitude and felt encouraged to pursue their diabetes goals.
Conclusions on Replicating this in Other Health Centers
We cannot conclude that follow up phone calls improve hemoglobin A1c levels in diabetic patients. However, the contacted patients appreciated the follow up and may have benefited in unmeasurable ways such as their willingness to continue working towards their diabetic goals and increased trust in their PCP. Other health centers might consider replicating this project, but implementing a longitudinal plan for long term follow- up phone calls may be worth investigating.
The study size ended up smaller than expected and this greatly limited our findings and assessment. Our inclusion criteria, narrow timeframe, difficulty reaching patients via phone, language barriers, no show rates (57% no show rate), and lack of hemoglobin A1c draw on follow-up all contributed to our small study size. Also, most of the patients were contacted only a few weeks before their appointment due to the narrow timeframe. This did not leave much time for the hemoglobin A1c levels to show improvement, since it accounts for the glucose levels over the previous 3 months.