Journal of General Internal Medicine

, Volume 17, Issue 7, pp 521–530 | Cite as

The use of computerized birthday greeting reminders in the management of diabetes

  • Jennifer Elston Lafata
  • Ann M. Baker
  • George W. Divine
  • Bruce D. McCarthy
  • Hugo Xi
Original Articles


BACKGROUND: Although mailed reminders have been used for prevention among general populations, few studies have evaluated their effectiveness among chronically ill populations.

OBJECTIVE: We evaluated the effectiveness of mailed reminders for improving diabetes management. The reminder included a letter from the individual’s primary care physician (PCP), a self-care handbook, a preventive care checklist, and specific recommendations regarding receipt of routine monitoring and screening.

METHODS: Of 195 PCPs practicing with a large group practice, 111 agreed to have their adult patients with diabetes randomized to receive the reminder (n=1,641) or usual care (n=1,668). Using data from automated databases, we fit generalized estimating equations to evaluate the effect of reminder receipt on fasting lipid profile and glycated hemoglobin testing, dilated retinal exam receipt, and visit frequency during the 6 and 12 months following randomization, and glycated hemoglobin and cholesterol levels in the year following randomization.

RESULTS: Reminder and usual care recipients did not differ in sociodemographic, clinical, or prior testing characteristics. In the 6 months following randomization, reminder recipients were more likely to receive a retinal exam (odds ratio [OR], 1.29; 95% confidence interval [95% CI], 1.12 to 1.49) and diabetes visit (OR, 1.28; 95% CI, 1.12 to 1.47). In the 12 months following randomization, reminder recipients were more likely to receive a glycated hemoglobin test (OR, 1.21; 95% CI, 1.03 to 1.43), retinal exam (OR, 1.23; 95% CI, 1.07 to 1.41), and diabetes visit (OR, 1.25; 95% CI, 1.09 to 1.29). In the follow-up year, reminder recipients also tended to have a glycated hemoglobin test that did not reflect poor control (<9.5%).

CONCLUSIONS: We found small but significant improvements in the management of patients with diabetes receiving a computerized mailed reminder.

Key words

diabetes patient mailed reminders prevention health care use chronic disease management 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Diabetes Association. Clinical practice recommendations-1998. Diabetes Care. 1998;21:1S-95S.Google Scholar
  2. 2.
    Wisdom K, Fryzek JP, Havstad SL, Anderson RM, Dreiling MC, Tilley BC. Comparison of laboratory test frequency and test results between African-Americans and Caucasians with diabetes: opportunity for improvement. Diabetes Care. 1997;20:971–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Harris MI. Medical care for patients with diabetes: epidemiological aspects. Arch Intern Med. 1996;124:117–22.Google Scholar
  4. 4.
    Hiss RG. Barriers to care in non-insulin-dependent diabetes mellitus: the Michigan experience. Arch Intern Med. 1996;124:146–8.Google Scholar
  5. 5.
    Weiner JP, Parente ST, Garnick DW, Fowles J, Lawthers AG, Palmer H. Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetes. JAMA. 1995;273:1503–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behaviors related to diabetes mellitus in the U.S. Physician Adherence to Consensus recommendations. Diabetes Care. 1993;16:1507–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Brechner RJ, Cowie CC, Howie JL, Herman WH. Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA. 1993;270:1714–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Peterson KA. Diabetes care by primary care physicians in Minnesota and Wisconsin. J Fam Pract. 1994;38:361–7.PubMedGoogle Scholar
  9. 9.
    Martin TL, Selby JV, Zhang D. Physician and patient prevention practices in NIDDM in a large urban managed-care organization. Diabetes Care. 1995;18:1124–32.PubMedCrossRefGoogle Scholar
  10. 10.
    Marshal CL, Bluestein M, Chapin C, et al. Outpatient management of diabetes mellitus in five Arizona Medicare managed care plans. Am J Med Qual. 1996;11:87–93.Google Scholar
  11. 11.
    Elston Lafata J, Martin S, Morlock R, Divine GW, Xi H. Provider type and the receipt of general and diabetes related preventive health services among patients with diabetes. Med Care. 2000;39:491–9.CrossRefGoogle Scholar
  12. 12.
    U.S. Department of Health and Human Services. Health People 2010. Understanding and Improving Health. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  13. 13.
    Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11:1–47.PubMedGoogle Scholar
  14. 14.
    Szilagyi PG, Bordley C, Vann JC, et al. Effect of patient reminder/recall interventions on immunization rates. A review. JAMA. 2000;284:1820–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Pearson D, Jackson LA, Winkler B, Foss B, Wagener B. Use of an automated pharmacy system and patient registries to recruit HMO enrollees for an influenza campaign. Eff Clin Pract. 1999;2:17–22.PubMedGoogle Scholar
  16. 16.
    Baker AM, McCarthy BD, Gurley VF, Ulcickas Yood M. Influenza immunization in a managed care organization. J Gen Intern Med. 1998;13:469–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Smith DM, Zhou XH, Weinberger M, Smith F, McDonald RC. Mailed reminders for area-wide influenza immunization: a randomized controlled trial. J Am Geriatr Soc. 1999;47:1–5.PubMedGoogle Scholar
  18. 18.
    Skinner CS, Strecher VJ, Hospers H. Physicians’ recommendations for mammography: do tailored messages make a difference? Am J Public Health. 1994;84:43–9.PubMedGoogle Scholar
  19. 19.
    Wagner TH. The effectiveness of mailed patient reminders on mammography screening: a meta-analysis. Am J Prev Med. 1998;14:64–70.PubMedCrossRefGoogle Scholar
  20. 20.
    Margolis K, Menart TC. A test of two interventions to improve compliance with scheduled mammography appointments. J Gen Intern Med. 1996;11:539–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Mayer JA, Bartholomew S, Clapp EJ, Elder J. Facility-based inreach strategies to promote annual mammograms. Am J Prev Med. 1994;10:353–6.PubMedGoogle Scholar
  22. 22.
    Richardson A, Williams S, Elmwood M, Bahr M, Medicott T. Participation in breast cancer screening: randomised controlled trials of doctors’ letters and of telephone reminders. Aust J Public Health. 1994;18:290–2.PubMedCrossRefGoogle Scholar
  23. 23.
    Clayton AE, McNutt LA, Homestead HL, Hartman TW, Senecal S. Public health in managed care: a randomized controlled trial of the effectiveness of postcard reminders. Am J Public Health. 1999;89:1235–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Burack RC, Gimotty PA, McBride S, et al. How reminders given to patients and physicians affected pap smear use in a health maintenance organization. Results of a randomized controlled trial. Cancer. 1998;82:2391–400.PubMedCrossRefGoogle Scholar
  25. 25.
    O’Connor AM, Griffiths CJ, Underwood MR, Eldridge S. Can postal prompts from general practitioners improve the uptake of breast screening? A randomised controlled trial in one east London general practice. J Med Screen. 1997;5:49–52.Google Scholar
  26. 26.
    Armstrong K, Berlin M, Schwartz JS, Propert K, Ubel PA. Educational content and the effectiveness of influenza vaccination reminders. J Gen Intern Med. 1999;14:695–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Skaer TL, Sclar DA, Markowski DJ, Won JKH. Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension. J Hum Hypertens. 1993;7:515–8.PubMedGoogle Scholar
  28. 28.
    Skaer TL, Sclar DA, Markowski DJ, Won JKH. Effect of value-added utilities on prescription refill compliance and medicaid health care expenditures-a study of patients with non-insulin-dependent diabetes mellitus. J Clin Pharm Ther. 1993;18:295–9.PubMedGoogle Scholar
  29. 29.
    Baker AM, Elston Lafata J, Ward RE, Whitehouse FW, Divine G. A web-based diabetes care management support system. J Comm J Qual Improv. 2001;27:179–90.Google Scholar
  30. 30.
    Channing L. Bete Co., Inc. Living Well with Diabetes. A Handbook for People with Diabetes and Their Families. South Deerfield, Mass: Channing L. Bete, Co., Inc.; 1998.Google Scholar
  31. 31.
    U.S. Bureau of the Census. Census of Population and Housing, 1990; Summary tape file 3 on CD-ROM, Washington, DC: U.S. Census Bureau; 1992.Google Scholar
  32. 32.
    Selby JV, Thomas Ray G, Zhang D, Colby CJ. Excess costs of medical care for patients with diabetes in a managed care population. Diabetes Care. 1998;20:1396–402.CrossRefGoogle Scholar
  33. 33.
    Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus treated by different systems and specialties: results from the medical outcomes study. JAMA. 1995;274:1436–44.PubMedCrossRefGoogle Scholar
  34. 34.
    National Committee on Quality Assurance. The State of Managed Care Quality, 2001. Comprehensive Diabetes Care. Available at: Accessed December 20, 2001.Google Scholar
  35. 35.
    Ridout MS, Demetrio CGB, Firth D. Estimating intraclass correlation for binary data. Biometrics. 1999;55:137–48.PubMedCrossRefGoogle Scholar
  36. 36.
    Elston RC. Comments on estimating heritability of a dichotomous trait. Biometrics. 1977;33:232–3.Google Scholar
  37. 37.
    Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.CrossRefGoogle Scholar
  38. 38.
    SAS Institute Inc. SAS/STAT Software: Changes and Enhancements for Release 6.12. Cary, NC: SAS Institute Inc.; 1996.Google Scholar
  39. 39.
    Legorreta AP, Hasan MM, Peters AL, Pelletier KR, Leung KM. An intervention for enhancing compliance with screening recommendations for diabetic retinopathy. Diabetes Care. 1997;20:520–3.PubMedCrossRefGoogle Scholar
  40. 40.
    Halbert RJ, Nichol JM, Kwan-Moon L, Legorreta A. Effect of multiple patient reminders in improving diabetic retinopathy screening. A randomized trial. Diabetes Care. 1999;22:752–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Gilmer TP, O’Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care. 1997;20:1847–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–44.PubMedCrossRefGoogle Scholar
  43. 43.
    Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.PubMedCrossRefGoogle Scholar
  44. 44.
    National Committee on Quality Assurance. The State of Managed Care Quality, 2001. Key Findings. Available at: Accessed December 20, 2001.Google Scholar

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Jennifer Elston Lafata
    • 3
  • Ann M. Baker
    • 3
  • George W. Divine
    • 3
    • 1
  • Bruce D. McCarthy
    • 3
    • 2
  • Hugo Xi
    • 3
  1. 1.the Department of Biostatistics and Research EpidemiologyHenry Ford Health SystemDetroit
  2. 2.the Henry Ford Medical GroupHenry Ford Health SystemDetroit
  3. 3.Center for Health Services ResearchHenry Ford Health SystemDetroit

Personalised recommendations