Feedback Can Improve MDs' Diabetes Care

TUCSON, ARIZ. — Providing physicians with semiannual or quarterly feedback on their ability to manage their patients' glycemic control, as reflected by hemoglobin A_1c levels, could improve suboptimal diabetes care in primary care settings, Dr. Yar Pye and colleagues reported in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Pye reported on data from a 30-month observational study in which physicians received feedback regularly with regard to their patients' average hemoglobin A_1c values, the percentage of patients with data on HbA_1c for the last 6 months, and the percentage of patients with controlled and uncontrolled diabetes. The physicians also were informed about the average HbA_1c level for the whole clinic and their peers, Dr. Pye said in an interview. Patients were not given the information.

There were 360 nonpregnant diabetic patients, aged 27–89 years, being seen at the Lutheran Family Medical Center in Brooklyn, N.Y., where Dr. Pye practices. Two-thirds were female; the median age was 61 years.

Performance profiles were sent once in 2004, twice in 2005, and quarterly in 2006 until June 2006. Patients who did not have an HbA_1c value for the previous 6 months or who had uncontrolled diabetes, defined as a HbA_1c of more than 9.5%, were telephoned by staff or notified by mail for retesting and further treatment.

The average HbA_1c level decreased from 8.3% in December 2004 to 7.7% in June 2006, the authors wrote. During the same time period, the percentage of diabetic patients with a known HbA_1c increased from 75% to 83%, while the percentage of patients with uncontrolled diabetes decreased from 23% to 16%.

HbA_1c, which is not subject to the fluctuations seen with daily blood glucose monitoring, is being used increasingly as a target in glycemic control. In 2006, New York City took an unprecedented step when it mandated that all laboratories report HbA_1c test results directly to the New York City Department of Health.

The Canadian Institute for Health Information recently introduced semiannual tracking of HbA_1c as one of 105 primary health care indicators, Dr. Pye said. The American Diabetes Association recommends that HbA_1c be measured in patients with diabetes at least twice yearly.