An Evaluation of Communication Methods for Community Outreach in Patients with Diabetes

Abstract

Research Objectives

To prevent health complications, patients with type 2 diabetes mellitus should be regularly seen by their medical provider and routinely checked for hemoglobin A1c levels. However, many patients do not return for routine visits. The objective was to evaluate the efficacy of two communication modalities in scheduling patient appointments.

Study Design/Methods

Patients with a hemoglobin A1c > 9.0 not seen in clinic in >6 months were randomly assigned to a control or experimental group. All participants received an initial text message offering help with scheduling an appointment. The control group was contacted via a second text message and the experimental group was contacted via phone call. Additionally, the experimental group was asked to identify perceived healthcare barriers. In addition to the reported barriers, data included patients who scheduled and kept appointments in each group when data was available. Chi-squared test (p-value of <0.001) was performed.

Principal Findings and Quantitative Results

The total number of patients with an HbA1c greater than 9.0% was 416. A total of 156 were contacted with 34 (21.8%) participating. Twenty-five (16.0%) were lost to follow-up. Sixteen patients (47.1%) responded to voice and 18 (52.9%) to text. A chi-squared test with a value of 49.67 (p-value of <0.001) determined our findings significant. Ten (6.4%) were scheduled for follow-up. A larger proportion of patients received an appointment via voice (6 of 16, 37.5%) than text (4 of 18, 22.2%) with a chi-squared value of 118.56 (p-value of <0.0001).

Conclusions/Impact on Health Centers

The study demonstrated that combined use of text messaging and phone calls could lead to higher rates of scheduled appointments. Future studies could address whether appointments made with this method of contact are kept. One factor that limited scheduled appointments was that 16% of patients indicated they were no longer being seen at El Rio. This suggests the need for an additional feature to be placed in NextGen where staff can indicate that patients are no longer being followed. Results of our research will be presented at El Rio Research Fair in May 2019.