Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO).
Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI (ML).
Hawaii J Health Soc Welf. 2022 Dec;81(12):323-327.
The American Diabetes Association (ADA) recommends hemoglobin A1C (A1C) goals of < 7% for most non-pregnant adults and < 8% for adult patients with extensive or life-limiting comorbidities. A1C testing is indicated every 3-months for patients not meeting goals to assess glycemic control, adjust medications, suggest lifestyle changes, and offer counseling. However, many patients do not adhere to routine testing. A clinic-wide quality improvement (QI) pilot project was implemented using mailed reminder letters to improve patient adherence to routine A1C testing in patients with hemoglobin A1C . 8%. Sixty-eight patients were identified for this letter intervention. Of these, 14 patients (20%) were historically adherent to 3-month interval testing, 31 patients (46%) were historically non-adherent, and 23 (34%) had historical A1C test intervals of less than 3-months because of provider orders. The primary outcome was improvement in A1C testing adherence rates of those who were previously non-adherent. There was a 58% increase overall and a 103% increase in testing rates among women. Statistical significance was not observed at the P = .05 level. However, improvement in adherence rates among women reached the P = .10 significance level. Mailed reminder letters may be useful in improving adherence to routine A1C testing in patients with diabetes. Further study of this intervention in larger groups is needed to provide timely data for the management of diabetes care.
美国糖尿病协会 (ADA) 建议大多数非妊娠成年人的血红蛋白 A1C (A1C) 目标<7%，而有广泛或生命有限合并症的成年患者的目标<8%。对于未达到目标的患者，每 3 个月进行一次 A1C 检测，以评估血糖控制情况、调整药物、建议生活方式改变并提供咨询。然而，许多患者并未遵循常规检测。实施了一项全诊所质量改进 (QI) 试点项目，使用邮寄提醒信来提高患者对 A1C 常规检测的依从性，A1C 水平为 8%。有 68 名患者符合此信函干预条件。其中，14 名患者（20%）既往 3 个月间隔检测依从性良好，31 名患者（46%）既往不依从，23 名患者（34%）因医嘱而 A1C 检测间隔小于 3 个月。主要结局是提高既往不依从患者的 A1C 检测依从率。总体依从率提高了 58%，女性检测率提高了 103%。在 P=0.05 水平未观察到统计学意义。然而，女性的依从率提高达到了 P=0.10 的显著性水平。邮寄提醒信可能有助于提高糖尿病患者对常规 A1C 检测的依从性。需要在更大的人群中进一步研究这种干预措施，以便为糖尿病护理管理提供及时的数据。
