Providing customized clinical information to patients and physicians does not improve diabetes care

Outcomes/Effectiveness Research
Providing customized clinical information to patients and physicians does not improve diabetes care

Patients with diabetes continue to have trouble meeting their goals for blood glucose levels, blood pressure readings, and LDL ("bad") cholesterol levels. Delivering customized clinical information to patients and their physicians failed to improve outcomes in these patients, according to a new study.

Patrick J. O'Connor, M.D, M.P.H., of the Health Partners Research Foundation in Minneapolis, and colleagues included 123 primary care physicians and 3,703 adults with diabetes who had elevated hemoglobin A1c (a measure of long-term blood glucose control) or LDL cholesterol levels. All were randomized to one of four groups. In the patient-only group, individuals received a customized, four-page brochure in the mail every 4 months with detailed information of their A1c and LDL trends along with medication recommendations and checklists to discuss with their doctors.

Physicians in the physician-only group received printed lists of their diabetic patients every 4 months with information on their A1c and LDL cholesterol levels along with recommendations to adjust therapy when necessary. A third group had both patients and physicians receiving the customized information. Finally, in the fourth group, neither patient nor physician received any of this information (control group). Twelve months after the customized interventions, there was no significant improvement in the ordering of A1C tests. Testing rates for LDL cholesterol actually were lower for all three of the intervention groups compared with the control group.

The interventions had no effect on LDL cholesterol values; these improved in all patient groups. The interventions also had no impact on the likelihood that physicians would intensify therapy in patients not at their targeted A1c or LDL cholesterol goals. According to the researchers, customized information mailings are actively being sent to patients by large medical practices. Given the results of this study, they recommend that such interventions be re-evaluated to determine what, if any, benefit they provide to patients. The study was supported in part by the Agency for Healthcare Research and Quality (HS11919).

See "Customized feedback to patients and providers failed to improve safety or quality of diabetes care," by Dr. O'Connor, JoAnn Sperl-Hillen, M.D., Paul E. Johnson, Ph.D., and others in Diabetes Care 32(7), pp. 1158-1163, 2009.