Impact of telephone and mail intervention on appointment adherence and clinical outcomes among patients with diabetes

Abstract

Objectives: Clinical pharmacists can play an important role in diabetes management if patients keep their appointments. However, the impact of telephone/mail contact methods on clinical pharmacists' appointment adherence and the relationship between clinical pharmacist visits and A1C (haemoglobin A1c) outcomes has not been examined. The objective was to determine whether contact method type (telephone versus mail) had an impact on appointment adherence and the relationship between clinical pharmacist visits and number of A1C tests and change in A1C levels. Methods: This was a retrospective database study using CommUnityCare outpatient electronic medical records from 1 September 2009 to 13 January 2012. Included patients were adults (18-80 years) with type 2 diabetes mellitus and an A1C>9%. Patients were contacted by telephone, and those who could not be reached were contacted by mail. Contact method type, number of clinical pharmacist visits, number of A1C tests, A1C levels and patient characteristics were collected. Appointment-keeping was calculated as kept visits/total number of patients in each contact method group. Key findings: Patients (n=131) were 53.3±12.4 years, 52.3% female, 72.7% Hispanic, 30.5% non-English-speaking and had an average A1C level of 11.0%±1.7% at baseline. Patients' appointment adherence rates (raw numbers; rate) for telephone (51/66; 77.2%) were higher than for mail (14/43; 32.6%) and telephone/mail (4/22; 18.2%) contact methods. Patients who visited the pharmacist≥3 times had more (P=0.03) A1C tests (3.5±2.1) than patients who visited the pharmacist 1-2 times (2.0±1.2). Change in A1C from baseline to last visit as well as 2-year follow-up was higher (P<0.05) in patients with at least 3 visits (-2.1%±2.1%; -2.3%±2.3%) compared to no visits (-0.6%±2.5%; -0.4%±2.3%). Conclusion: An appointment adherence rate of 53% and improvements in A1C values were observed in this study. Healthcare practitioners should consider calling or mailing patients with uncontrolled type 2 diabetes to increase appointment adherence and to help patients better control their diabetes. © 2013 Royal Pharmaceutical Society.