Research Activities, January 2011: Chronic Disease: Most patients with type 2 diabetes suffer an adverse event between office visits

Chronic Disease
Most patients with type 2 diabetes suffer an adverse event between office visits

Patients with type 2 diabetes (formerly called adult-onset diabetes) must self-manage their diet, exercise, medication, and blood-glucose testing to keep control of their disease. When patients must manage a chronic disease like diabetes at home, there is a potential for safety problems. In fact, a new study reveals that most patients treated for type 2 diabetes in a physician's office suffer from an adverse event (AE) or potential AE between office visits. Of 111 patients who used an automatic telephone support system for self-managing their diabetes, 86 percent had at least one AE detected over the 9-month observation period (111 AEs and 153 potential AEs). The majority of real and potential events were found to be related to medication management (63 percent). A single contributing cause was noted for only 20 percent of the events.

The remaining 80 percent were due to a combination of system, clinician, and patient factors. Patient actions, such as not connecting symptoms with medication problems, contributed to the cause of 77 percent of AEs. Systems issues, such as test results not sent to the primary care physician, contributed to 69 percent of AEs. Inadequate physician-patient communication contributed to 59 percent of AEs. Primary care physician problems other than communication contributed to only 16 events (6 percent). The study was part of the 9-month Improving Diabetes Efforts Across Language and Literacy (IDEALL) project, using those patients who were assigned to the automated telephone self-management (ATSM) support program. The researchers measured patient health literacy in the English- and Spanish-speaking patients only.

The IDEALL ATSM intervention included weekly interactive automated telephone calls to patients, with review and followup by a nurse care manager if the patient's responses indicated problems in an area of self-care, such as hypoglycemia (excessively low blood-glucose levels), considered a candidate AE or potential AE. A patient could request a call back from a nurse during any ATSM session or report an unrelated event during a live followup call from a nurse. The study was funded in part by the Agency for Healthcare Research and Quality (HS17594, HS14864, and HS17261).

More details are in "What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes," by Urmimala Sarkar, M.D., Margaret A. Handley, Ph.D., M.P.H., Reena Gupta, M.D., and others in the June 2010 Quality and Safety in Health Care 19(3), pp. 223-228.
Research Activities, January 2011: Chronic Disease: Most patients with type 2 diabetes suffer an adverse event between office visits