The use of computerized birthday greeting reminders in the management of diabetes.
BACKGROUND
Although mailed reminders have been used for prevention among general populations, few studies have evaluated their effectiveness among chronically ill populations.


OBJECTIVE
We evaluated the effectiveness of mailed reminders for improving diabetes management. The reminder included a letter from the individual's primary care physician (PCP), a self-care handbook, a preventive care checklist, and specific recommendations regarding receipt of routine monitoring and screening.


METHODS
Of 195 PCPs practicing with a large group practice, 111 agreed to have their adult patients with diabetes randomized to receive the reminder (n = 1,641) or usual care (n = 1,668). Using data from automated databases, we fit generalized estimating equations to evaluate the effect of reminder receipt on fasting lipid profile and glycated hemoglobin testing, dilated retinal exam receipt, and visit frequency during the 6 and 12 months following randomization, and glycated hemoglobin and cholesterol levels in the year following randomization.


RESULTS
Reminder and usual care recipients did not differ in sociodemographic, clinical, or prior testing characteristics. In the 6 months following randomization, reminder recipients were more likely to receive a retinal exam (odds ratio [OR], 1.29; 95% confidence interval [95% CI], 1.12 to 1.49) and diabetes visit (OR, 1.28; 95% CI, 1.12 to 1.47). In the 12 months following randomization, reminder recipients were more likely to receive a glycated hemoglobin test (OR, 1.21; 95% CI, 1.03 to 1.43), retinal exam (OR, 1.23; 95% CI, 1.07 to 1.41), and diabetes visit (OR, 1.25; 95% CI, 1.09 to 1.29). In the follow-up year, reminder recipients also tended to have a glycated hemoglobin test that did not reflect poor control (<9.5%).


CONCLUSIONS
We found small but significant improvements in the management of patients with diabetes receiving a computerized mailed reminder.
Center for Health Services Research, Henry Ford Health System, Detroit, Mich 48202, USA. jlafata@hfhs.org
Jennifer Elston
JE
Lafata
Ann M
AM
Baker
George W
GW
Divine
Bruce D
BD
McCarthy
Hugo
H
Xi
D000846:Anniversaries and Special Events; D003920:Diabetes Mellitus / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012042:Registries; D017010:Reminder Systems