Interactive computer programs, which include specific diabetes care protocols and customized self-management action plans, can improve diabetes care in typical primary care practices, according to a study supported by the Agency for Healthcare Research and Quality (HS10123). Researchers led by Russell E. Glasgow, Ph.D., of Kaiser Permanente Colorado, compared the ability of an interactive CD-ROM-assisted Diabetes Priority Program to improve laboratory tests, patient-centered care, and outcomes of 886 patients with type 2 diabetes. The researchers randomized 52 primary care physicians in Colorado (and their 886 patients) to the computer program (intervention) or a control group.
The intervention group completed a computerized touch screen assessment that included questions about receipt of recommended procedures such as foot examinations and dilated eye exams, as well as five laboratory assessments and four patient-centered activities such as self-monitoring of blood glucose. Patients were also asked about smoking, exercise, and eating patterns and received feedback on each of these. They next selected a behavior change goal in the area of smoking, eating, or exercise. The program generated a self-management action plan, which was also printed out for the doctor and care manager.
Patients in the control group completed a computer assessment and received a printout on general health risk reduction. They did not have a care manager. More than half of patients (from 58 to 99 percent) were already receiving recommended services. Despite this high initial level of care, the intervention group received rates of care averaging 17 percent higher than the control group, with greatest differences in medical nutrition therapy, self-management goal setting, dilated eye exams, and foot exams. Outcomes such as blood-sugar levels improved overall, with no significant difference between groups.
See "Randomized effectiveness trial of a computer-assisted intervention to improve diabetes care," by Dr. Glasgow, Paul A. Nutting, M.D., M.S.P.H., Diane K. King, M.S., O.T.R., and others, in the January 2005 Diabetes Care 28(1), pp. 33-39.
Editor's Note: A second report by the same researchers found that patients were very willing to participate in the computer-assisted intervention, and staff in primary care offices can consistently deliver an intervention of this nature. However, most physicians were unwilling to participate in the study, requiring implementation of computer-assisted care during regular primary care visits. See Glasgow, R.E., Nutting, P.A., King, D.K., and others (2004, December). "A practical randomized trial to improve diabetes care." (AHRQ grant HS10123). Journal of General Internal Medicine 19, pp. 1167-1174.
Another AHRQ-supported study on the costs of care for adult diabetes patients found that coronary heart disease, hypertension, and depression disorders among these patients more strongly predict future care costs than blood sugar levels. For more details, see Gilmer, T.P., O'Connor, P.J., Rush, W.A., and others (2005, January). "Predictors of health care costs in adults with diabetes." (AHRQ grant HS09946). Diabetes Care 28(1), pp. 59-64.
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