Impact of telephonic interventions on glycosylated hemoglobin and low-density lipoprotein cholesterol testing.
OBJECTIVE
To determine whether diabetes disease management (DM) programs are able to improve adherence to glycosylated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C) clinical testing in a nonadherent population and to quantify the efficacy of telephonic interventions in improving clinical testing rates.


METHODS
Retrospective, observational cohort study before and after DM program implementation.


METHODS
A baseline cohort of members with diabetes (n = 5640) was identified from among large-scale diabetes DM programs administered for 13 geographically diverse health plans. Members were defined by nonadherence at baseline to A1C and/or LDL-C testing, grouped together based on how long they had participated in the program, divided retrospectively into telephonically contacted and uncontacted groups, and analyzed in the subsequent 12-month implementation period for testing rates. Subgroups defined by disease burden at baseline and frequency of telephonic interactions were analyzed to determine achievement of guideline-based A1C and LDL-C testing rates.


RESULTS
Participation in diabetes DM programs was associated with improved A1C and LDL-C testing rates in previously nonadherent members. Calling nonadherent members improved A1C testing by 30.2% and LDL-C testing by 10.9% compared with testing rates for members who were not called. Members with high disease burden benefited even more from the diabetes intervention. Frequency of telephonic contacts with nonadherent individuals demonstrated a linear relationship with improved rates of adherence to A1C and LDL-C testing guidelines, and markedly improved testing rates compared with a not-called group.


CONCLUSIONS
Telephonic interventions as part of comprehensive DM programs are associated with improved disease-monitoring testing.
Coberley
Carter
C
Healthways, Inc., Nashville, TN, USA. carter.coberley@healthways.com
Hamar
Brent
B
Gandy
Bill
B
Orr
Patty
P
Coberley
Sadie
S
McGinnis
Matthew
M
Hudson
Laurel
L
Forman
Sam
S
Shurney
Dexter
D
Pope
James
J
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013689:Telephone
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin