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

Abstract

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.