Individualized Feedback Does Not Improve Diabetes Care

Dr. Patrick J. O’Connor from HealthPartners Research Foundation, Minneapolis, Minnesota, stated that, “It is never too late to learn new tricks, and for most of us, it is a good idea to avail ourselves of whatever learning strategies and decision support strategies we feel are useful to support our individual efforts to improve the chronic disease care we deliver.”

 

Dr. O’Connor and colleagues assessed whether feedback of specific clinical information to patients only, physicians only, or to both patients and their physicians improved quality or safety of diabetes care compared with the results obtained by a usual-care control group that received no intervention.

 

Hemoglobin A1c and LDL cholesterol improved in all groups during the study period, the authors report.

 

A1c test rates during the first 6 months of the study were significantly lower in the intervention groups than in the control group among patients not using insulin and were lower in the physician intervention group among insulin users.

 

By the end of the 12-month study, though, there were no significant differences in A1c test rates among the groups.

 

The physician interventions had no significant impact on the likelihood of intensification of treatment for patients not at their A1c or LDL cholesterol goals, the researchers note, and the interventions had no apparent impact on inappropriate pharmacotherapy for A1c or LDL cholesterol control.

 

Patients in the intervention groups tended to take longer to have their next primary care visit than did those in the control group, the investigators say, as did patients in the physician intervention group.

 

“Customized patient mailings such as those tested in this study are being widely implemented in an unevaluated way by many large medical groups and disease management programs on the assumption that such communications will improve diabetes care,” the authors conclude.

 

“Based upon our results, this practice should be questioned, and further efforts to substantiate purported benefits are urgently needed.”

 

“We have since developed and tested a more sophisticated simulated-learning intervention for physicians that uses more cases and takes about three hours to do,” Dr. O’Connor said. “It covers a broader clinical terrain including blood pressure and lipid, as well as glucose care in adults with Type 2 diabetes. The preliminary data on the newer version are also positive, for better glucose and to some extent, better blood pressure control.”

 

“We are extending this technology to the care of patients with other chronic diseases, and developing a version that is designed to be used by primary care residency programs,” Dr. O’Connor added. “Our most recent version of these tools will be accessible via the Web, and may have broad application if it works as well as the earlier versions have.”