Impact of Telephonic Interventions on Glycosylated Hemoglobin and Low-density Lipoprotein Cholesterol Testing

Published in American Journal of Managed Care

Author(s): Carter Coberley, PhD; Brent Hamar, DDS, MPH; Bill Gandy, EdD; Patty Orr, RN, EdD; Sadie Coberley, PhD; Matthew McGinnis, BS; Laurel Hudson, RN, MSN; Sam Forman, MD, MPH, MBA; Dexter Shurney, MD, MPH, MBA; and James Pope, MD

Objectives: To determine whether diabetes disease management (DM) programs are able to improve adherence to glycosylated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C) clinical testing in a nonadherent population and to quantify the efficacy of telephonic interventions in improving clinical testing rates.

Study Design: Retrospective, observational cohort study before and after DM program implementation.

Methods: A baseline cohort of members with diabetes (n = 5640) was identified from among large-scale diabetes DM programs administered for 13 geographically diverse health plans. Members were defined by nonadherence at baseline to A1C and/or LDL-C testing, grouped together based on how long they had participated in the program, divided retrospectively into telephonically contacted and uncontacted groups, and analyzed in the subsequent 12-month implementation period for testing rates. Subgroups defined by disease burden at baseline and frequency of telephonic interactions were analyzed to determine achievement of guideline-based A1C and LDL-C testing rates.

Results: Participation in diabetes DM programs was associated with improved A1C and LDL-C testing rates in previously nonadherent members. Calling nonadherent members improved A1C testing by 30.2% and LDL-C testing by 10.9% compared with testing rates for members who were not called. Members with high disease burden benefited even more from the diabetes intervention. Frequency of telephonic contacts with nonadherent individuals demonstrated a linear relationship with improved rates of adherence to A1C and LDL-C testing guidelines, and markedly improved testing rates compared with a not-called group.

Conclusion: Telephonic interventions as part of comprehensive DM programs are associated with improved disease-monitoring testing.

Key Takeaways:

Hemoglobin A1c is an indicator of glycemic control in diabetes. A1c levels are associated with complications such as retinopathy, kidney failure and peripheral neuropathy.
• High LDL cholesterol is a risk factor for cardiovascular disease, as is diabetes.
• Telephonic disease management for patients with diabetes was associated with increased
  adherence to A1c and LDL testing.
• Clinical testing rates increased with an increasing number of successful calls to participants.