Patient computer use to prompt doctor adherence to diabetes management guidelines.
OBJECTIVE
Doctor compliance with diabetic care guidelines is low and may be improved with system-wide changes that include patient involvement. The objective of this study was to determine if patients in an internal medicine teaching clinic would use a touch-screen computer to receive personalized information regarding their need for diabetes care. Outcomes included determining if this intervention would improve resident doctor compliance with diabetic guidelines.


METHODS
In this prospective study a computer was available for patients to use independently in one clinic, while another computer was placed in a second clinic with nursing support. Patients responding they were diabetic to the first screen received screens covering HbA1c, blood pressure, cholesterol, foot, eye examinations and compliance with having labs drawn. Non-diabetic patients received three general health screens. A response-based report was printed for patients to share with their doctor. Chart reviews were conducted to assess diabetic health care delivery.


RESULTS
The computer was used voluntarily by 20.6% of patients in the primary clinic and by 100% of patients in the nurse-assisted clinic. A total of 104 patients from both clinics responded they were diabetic; over 50% did not know what HbA1c meant and a minority responded their HbA1c, blood pressure and cholesterol were at good levels. Significantly more HbA1c tests conducted within 6 months were documented in patients' charts.


CONCLUSIONS
Patients used the computer effectively without direction in the primary clinic. In this initial study, implementation of the computer program increased the number of HbA1c tests ordered. Future studies incorporating refinements may increase both usage and efficacy of this intervention.
Haller
Nairmeen A
NA
Internal Medicine, Department of Internal Medicine, Akron General Medical Center, Akron, OH, USA. nhaller@agmc.org
Gil
Karen M
KM
Gardner
William G
WG
Whittier
Frederick C
FC
D000328:Adult; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003194:Computer-Assisted Instruction; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012648:Self Care; D014584:User-Computer Interface
D006442:Glycated Hemoglobin