Go backSearch Session number: 1117

Abstract title: Improving the Process of Chronic Diabetes Care by Using Non-Visit Care

Author(s):
Robert White - New Mexico Veterans Affairs Health Sciences Center
Dave Graeber - New Mexico Veterans Affairs Health Sciences Center
Dan Gray - New Mexico Veterans Affairs Health Sciences Center

Objectives: VA primary care clinic staff should follow clinical practice guidelines in caring for diabetic patients during routine clinic visits; however, many guidelines are not fully achieved. We chose to accomplish two services (delivering pneumococcal vaccine and scheduling annual eye examinations) outside of routine, primary care visits. We identified the diabetic populations needing those services and used telephone contacts, chart reviews and reminder letters to accomplish them.

Methods: At our facility, two non-teaching, primary care teams have similar provider and support staff composition. Team A provides care to 944 diabetic patents and Team B to 997. For intervention Phase 1 (March-July 2001), nursing staff in A contacted those diabetic patients whose electronic record did not indicate receipt of pneumoccocal vaccine, and B nursing staff contacted diabetic patients needing eye examinations. During Phase 2 (July-September 2001) the roles were reversed. In Phase 2, we sought greater efficiency, so we sent letters to all targeted patients, advising them of their need for either vaccination (B) or eye examination (A). Patients were urged to respond by mail or phone, in order to arrange care.

Results: The percentages of A and B diabetic patients who received pneumococcal vaccine before the intervention, between October 2000 and February 2001 (coinciding with flu shot season), were similar: 14.8% in A and 13.1% in B. During Phase 1 intervention, another 11.1% of A patients received pneumococcal vaccine compared with only 1.5% of B patients (Chi square p<.05). During Phase 2, the percentages of diabetics receiving vaccine were 1.4% in A and 1.7% in B (non-signifcant differences). Regarding eye examinations, a computer report indicated that 72% of diabetic patients in A and 73% of those in B needed examinations before the intervention started. Following Phase 1 intervention, those numbers dropped more in B (B=43% vs. A=53%, Chi square p<.05). Following Phase 2, the numbers dropped further, but symmetrically and non-significantly (B=31% and A=43%).

Conclusions: Routine diabetic services were better accomplished when a population of patients was targeted for review outside of regular clinic visits. Review conducted by nurses was superior to that achieved with reminder letters.

Impact statement: To achieve better chronic disease outcomes, it is more productive to apply some guidelines outside of routine clinic visits.