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Using Reminder Letters to Improve Adherence to Routine Hemoglobin A1C Testing in Adults with Diabetes

Alvin C Yiu1, Sunny Park1, Michael Lustik2

  • 1Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (ACY, SP, AH, UAO).

Hawai'I Journal of Health & Social Welfare
|December 12, 2022
PubMed

Insights

Mailed reminder letters improved adherence to routine hemoglobin A1C (A1C) testing for diabetes patients not meeting glycemic goals. The intervention showed a 58% increase in testing rates, particularly among women.

Area of Science:

  • Internal Medicine
  • Endocrinology
  • Quality Improvement in Healthcare

Background:

  • The American Diabetes Association (ADA) recommends specific hemoglobin A1C (A1C) targets for diabetes management.
  • Routine A1C testing every 3 months is crucial for assessing glycemic control and guiding treatment adjustments.
  • Patient adherence to recommended A1C testing schedules remains a significant challenge in diabetes care.

Purpose of the Study:

  • To evaluate the effectiveness of mailed reminder letters in improving adherence to routine A1C testing.
  • To assess the impact of this quality improvement intervention on patients with A1C levels of 8% or higher.
  • To identify specific patient groups that may benefit most from reminder letter interventions.

Main Methods:

  • A clinic-wide quality improvement pilot project was conducted.
  • Mailed reminder letters were sent to 68 patients with A1C levels of 8% or higher who were not adhering to 3-month testing intervals.
  • The primary outcome measured was the improvement in A1C testing adherence rates among previously non-adherent patients.

Main Results:

  • An overall 58% increase in A1C testing adherence was observed.
  • Testing rates among women increased by 103%.
  • While not statistically significant at P = .05, improvements in adherence among women approached significance at P = .10.

Conclusions:

  • Mailed reminder letters show potential as a tool to enhance patient adherence to regular A1C testing.
  • The intervention demonstrated a notable positive impact, especially for female patients.
  • Further research with larger patient cohorts is recommended to validate these findings and inform diabetes management strategies.

Keywords:
Mailed Letter InterventionMilitary MedicineQuality ImprovementType II Diabetes Mellitus

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