title: The effect of electronic reminders on risk management among diabetic patients in low resourced settings.
abstract: BACKGROUND
  Information technology has potential to improve health care delivery particularly among individuals with chronic diseases such as diabetes in low and middle-income countries (LMIC). Research on the usefulness of information technology to manage persons living with chronic diseases is scarce in LMIC. We sought to evaluate the effect of an electronic reminder system on cardiovascular risk factors (blood pressure, heart rate, and fasting plasma glucose) and adherence to clinical appointments among persons living with diabetes.
  
  
  METHODS
  A randomized controlled design was used to recruit 200 diabetic patients (intervention n=100, control n=100) from the National Diabetes Management Research Centre, Accra. All patients received usual diabetes care. The intervention group was given electronic reminders for their clinical appointments and their physicians were prompted with abnormal laboratory results for six months.
  
  
  RESULTS
  Baseline characteristics were largely similar for both groups. At six months follow up, the mean reductions of all the cardiovascular risk factors in the intervention group were significantly greater than in the control group: -1.7 kg/m(2) versus -1.1 kg/m(2)(p=0.002) for BMI; -4.7 mmHg versus -2.8 mmHg (p=0.002) for SBP; -5.3 mmH versus -3.1 mmHg (p=0.001) for DBP; -1.7 bpm versus -0.1 bpm (p=0.001) for heart rate and -2.3 mmol/L versus -1.6 mmol/L (p=0.001) for fasting plasma glucose, respectively. Adherence to appointment schedules was also significantly higher in the intervention group compared with the control group (97.8% versus 89.4%, p=0.010).
  
  
  CONCLUSIONS
  Locally developed electronic initiatives such as this resulted in improved cardiovascular risk factors and effective compliance to clinical practices and improved quality of care for persons living with diabetes.
authors.affiliation: Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: dna@chs.edu.gh.
authors.forename: D N
authors.initials: DN
authors.lastname: Adjei
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: Bank of Ghana and Regent University, Accra, Ghana.
authors.forename: J B
authors.initials: JB
authors.lastname: Dasah
authors.affiliation: School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
authors.forename: P
authors.initials: P
authors.lastname: Kuranchie
authors.affiliation: Dept of Medicine, University of Ghana Medical School, College of Health Sciences, University of Ghana, National Diabetes Management and Research Centre, Accra, Ghana.
authors.forename: A G B
authors.initials: AG
authors.lastname: Amoah
mesh_terms: D000328:Adult; D000555:Ambulatory Care Information Systems; D001071:Appointments and Schedules; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003695:Delivery of Health Care; D003906:Developing Countries / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011203:Poverty; D017010:Reminder Systems; D012308:Risk Management / Q000458:organization & administration; D055815:Young Adult
keywords: Cardiovascular risk factors; Compliance; Diabetes; Electronic clinical reminder; Metabolic risk; Risk management