Patients and computers as reminders to screen for diabetes in family practice. Randomized-controlled trial

Abstract

Background: In New Zealand, more than 5% of people aged 50 years and older have undiagnosed diabetes; most of them attend family practitioners (FPs) at least once a year.

Objectives: To test the effectiveness of patients or computers as reminders to screen for diabetes in patients attending FPs.

Design: A randomized-controlled trial compared screening rates in 4 intervention arms: patient reminders, computer reminders, both reminders, and usual care. The trial lasted 2 months. The patient reminder was a diabetes risk self-assessment sheet filled in by patients and given to the FP during the consultation. The computer reminder was an icon that flashed only for patients considered eligible for screening.

Participants: One hundred and seven FPs.

Measurements: The primary outcome was whether each eligible patient, who attended during the trial, was or was not tested for blood glucose. Analysis was by intention to treat and allowed for clustering by FP.

Results: Patient reminders (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.21, 2.43), computer reminders (OR 2.55, 1.68, 3.88), and both reminders (OR 1.69, 1.11, 2.59) were all effective compared with usual care. Computer reminders were more effective than patient reminders (OR 1.49, 1.07, 2.07). Patients were more likely to be screened if they visited the FP repeatedly, if patients were non-European, if they were "regular" patients of the practice, and if their FP had a higher screening rate prior to the study.

Conclusions: Patient and computer reminders were effective methods to increase screening for diabetes. However, the effects were not additive.

FIGURE 1

Screen shot from MedTech 32 showing an active reminder at the right end of the toolbar and the text of the patient task near the bottom line of the screen shot

FIGURE 2

Flow diagram of family practitioner (FP) numbers in trial. ^*Not using MedTech 32 (474), not having electronic laboratory results for ≥1 year (75), not recording clinical notes on computer (32), not in Auckland (5), not an FP (9), 1 entry each for doctors working in 2 practices (7), and author T.K. (1). ^†Left practice, leaving practice, or on maternity leave (13), not willing or able—within the timeframe of this trial—to upgrade to the version of MedTech 32 needed for the computer intervention and data collection (15), not an FP (4), and saw <10 individual patients age ≥50 per month (2). ^‡Two FPs in the computer group, 2 in the patient group, and 1 in the usual group saw <10 individual patients age ≥50 per month