2007 (Oct) Canadian Diabetes Association Conference, poster presentation by BRAID Research

1. Results of a survey to assess patient memory of diagnosis
and compliance with referral for physician follow-up after diabetes
screening: the Mobile Diabetes Screening Initiative (MDSi) Dr. Ellen L. Toth,
Ellen L. Toth, Kelli Ralph-Campbell, Tracy Connor, Mary Pick, Kari Meneen, Gloria Fraser, MDSi Medical Lead
Department of Medicine, University of Alberta, Edmonton, AB
Abstract CLIENT RECALL: We wanted to find out if our clients correctly
RECALL: PHYSICIAN CONCORDANCE: We wanted to find out if clients
CONCORDANCE:
MDSi serves off-reserve Aboriginal and remote communities in Northern
“heard” what MDSi told them about their diabetes status.
heard” followed-up with their family physician for confirmatory testing, as
followed-
Alberta. Between Nov. 2003 and July 2006, MDSi screened 1328 clients for
undiagnosed diabetes. MDSi recommended. We also wanted to find out if MDSi screening
We designed a brief survey to understand client’s actions in response to diagnoses had been confirmed upon physician follow-up.
follow-
Group 1 (N = 40): Mean FPG = 7.6 mmol/L; Mean A1c = 6.6%
MDSi screening (i.e. seeing their family physician to confirm a positive
screening diagnosis). The survey additionally assessed client recall of their Clients Following-up With Family Physician Upon MDSi Recommendation:
MDSi diagnosis. Heard "N al",
orm
Heard "Diabetes",
After applying date parameters and exclusion criteria, we randomly A. Clients told they had 22%
11%
generated a total sample of 312 clients, divided into 3 groups: Group #1 “probable diabetes”: 100%
(N=118): Told “probable diabetes or IGT” (defined by FPG ≥7.0 mmol/L or
(N = 18) 80% No physician follow-up
A1c (≥6.1 mmol/L); Group #2 (N=75): Told “at risk for diabetes or pre-
diabetes” (defined by A1c ≥ 5.5 < 6.1 mmol/L); Group #3 (N=119): Told N Answer,
o Heard
60% Saw physician for different
matter
“normal” (defined by <5.5 mmol/L). [Group 3 will be reported elsewhere.] 17% "Pre-diabetes", 40% Saw physician about MDSi
Sixty-two clients from Groups 1 and 2 completed surveys, a 32% 50% results
20%
response rate. Surveys were conducted in English or Cree by telephone by
MDSi staff from July-Aug 2006. 0%
Group 1 (N = 40) Group 2 (N = 22)
Twenty-six clients (42%) remembered their MDSi diagnosis correctly; 13 B. Clients told they had N Answer, 23%
o
(21%) incorrectly remembered a less critical but still serious diagnosis (i.e. Heard "Diabetes",
“probable pre-diabetes/IGT”: 9% Physician Concordance With MDSi Diabetes Screening Diagnosis:
“impaired”, not “diabetes”). Therefore, overall 63% of clients at least
remembered there was concern about their diabetes status upon MDSi
(N = 22)
screening. 100%
Heard "Pre-diabetes",
76% of clients saw their family physician after being screened; MDSi’s 32%
80% Physician confirmation w/ blood
diagnosis was confirmed for 77% of clients who saw their family physician Heard "N al",
orm test
specifically regarding their MDSi results. 36% 60% Physician confirmation
MDSi is identifying a substantial number of people needing medical *Group 1 clients were screened between 2003-2006 40%
Physician follow-up
attention, who may otherwise be “missed” through conventional health care
20%
delivery.
22):
Group 2 (N = 22): Mean FPG = 6.3 mmol/L; Mean A1c = 5.8% 0%
Group 1 (N = 30)1 Group 2 (N = 17)2
N Answer, 5%
o
MDSi communities surveyed: Clients told they were Heard "Diabetes",
1Group 1: MDSi’s diabetes diagnosis was confirmed for 14 of the 20 clients who followed-up with
1: MDSi’ followed-
“at risk for diabetes 9%
their family physician regarding their MDSi screening results, and for 1 of the 10 clients who saw
and
Anzac Métis Settlements: or pre-diabetes”: their physician for a different reason. For 13 clients, MDSi’s diagnosis for weight, cholesterol
MDSi’
Conklin Buffalo Lake Heard "At Risk", Heard "N al",
orm
and/or blood pressure was confirmed. For 6 clients, confirmatory diabetes diagnosis was based
confirmatory
Evansburg East Prairie 68% 18% on repeat blood testing ordered by the clients’ physician.
clients’
Grande Cache Elizabeth 2Group 2: MDSi’s diabetes diagnosis was confirmed for 9 of the 11 clients who followed-up with
2: MDSi’ followed-
Hinton Fishing Lake their physician regarding their MDSi screening results. For 8, MDSi’s diagnosis for weight,
MDSi’
La Crete Gift Lake *Group 2 clients were screened 3-9 months prior to the survey
cholesterol and/or blood pressure was confirmed. For 8 clients, confirmatory diabetes and/or
Marlboro Kikino cholesterol diagnosis was based on repeat blood tests ordered by the clients’ physician.
clients’
Peerless Lake Paddle Prairie
Trout Lake Peavine Discussion: Few Group 1 respondents correctly recalled their MDSi screening
Discussion
Wabasca diagnosis. If Group 1 is representative of the sample as a whole, these survey
whole, Discussion: High rates of clients following-up with their family physician after
Discussion: following-
Wildwood results may suggest a degree of “denial”. However, 55% of Group 1 and 77% of
denial” MDSi screening (76% overall) is encouraging. Follow-up rates for Groups 1 and
Follow-
Group 2 respondents at least recalled there was concern about their diabetes
their 2 were similar, though proportionately more from Group 1 saw their physician
their
The Métis status, whether they correctly recalled their MDSi diagnosis, or incorrectly specifically regarding their MDSi results. This suggests MDSi is helping those
Settlements recalled a lesser or a more critical status (ex. told “pre-diabetes”, recalled most in need to connect with treatment. The high rates of physician
physician
pre-diabetes”
“diabetes”). This suggests MDSi effectively communicates messages to clients
diabetes” clients confirmation of MDSi’s diagnoses support the efficacy of MDSi’s methodology
MDSi’ MDSi’
Funding by Alberta Health
and Wellness about their general diabetes status. and the utility of community-based screening.
community-