Patient-directed intervention versus clinician reminders alone to improve aspirin use in diabetes: a cluster randomized trial.
BACKGROUND
Physician-directed approaches have not eliminated the underuse of effective preventive therapies.


METHODS
In a cluster-randomized design, 19 physicians caring for 334 eligible patients at least 40 years of age were randomized. All clinicians received computerized reminders at office visits. Intervention physicians received e-mails asking whether aspirin was indicated for each patient. If so, patients received a mailing and nurse telephone call addressing aspirin. The primary outcome was self-reported regular aspirin use.


RESULTS
Outcome assessment telephone interviews were completed for 242 (72.5%) patients. At follow-up, aspirin use was reported by 60 (46%) of the 130 intervention patients and 44 (39%) of the 112 reminder-only patients, a nonsignificant 7.2% difference (95% confidence interval: -3.9 to 18 percentage points, p = .20). In the subgroup reporting no aspirin use at baseline and no contraindications, 33 (43%) of the 76 intervention and 22 (30%) of the 74 reminder-only patients used aspirin, a 10% difference accounting for clustering (95% CI: 2.2 to 18 percentage points, p = .013).


CONCLUSIONS
A patient-directed intervention modestly increased aspirin use among diabetes patients beyond that achieved using computerized clinician reminders for ideal candidates. Obstacles included difficulty contacting patients, real or perceived contraindications, and failure to follow the nurse's advice.
Persell
Stephen D
SD
Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA. spersell@nmff.org
Denecke-Dattalo
Therese A
TA
Dunham
Daniel P
DP
Baker
David W
DW
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017010:Reminder Systems; D014481:United States
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin