Effects of between visit physician-patient communication on Diabetes Recognition Program scores.

OBJECTIVE

To determine whether physicians who interact with their patients between office visits using secure messaging and phone provide better care for patients with diabetes when controlling for physician, patient and care center characteristics.

DESIGN

Retrospective study.

SETTING

Kaiser Permanente Mid-Atlantic States.

PARTICIPANTS

174 Primary Care Physicians.

INTERVENTION

We modeled the relationship between communication via secure messaging or phone communication and Diabetes Recognition Program (DRP) scores with a Generalized Estimating Equations model. Covariates included physician age and panel size, patient age, race, income and number of comorbidities, and the population density around the care center.

MAIN OUTCOME MEASURE

DRP scores.

RESULTS

Physicians whose patients were predominantly white or mixed race were more likely than other physicians to use secure messaging and phone with their patients between visits, but there was no significant association between such contacts and DRP scores (P> 0.1). In contrast, physicians with predominantly black or Hispanic patients had significantly higher DRP scores associated with the use of secure messaging (P< 0.01) and higher, though not statistically significant, DRP scores associated with the use of phone (P< 0.1). These associations were strongest for outcome measures such as HbA1c and lipid levels, and were weaker or nonexistent for process measures such as annual foot and eye exams.

CONCLUSIONS

The use of secure messaging, and, to a lesser extent, phone, appears to be associated with higher quality diabetes care, particularly among at-risk populations.