Effects of Patient-Initiated Visits on Patient Satisfaction and Clinical Outcomes in a Type 1 Diabetes Outpatient Clinic: A 2-Year Randomized Controlled Study

Abstract

OBJECTIVE We investigated the effects of replacing regular outpatient follow-up through prescheduled visits with patient-initiated visits on patient satisfaction and clinical variables of type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS A 24-month randomized controlled trial in which adults with T1D were allocated to either patient-initiated unlimited access to outpatient visits or usual care through regular prescheduled visits. The primary outcome was seven patient-reported experience measures of patient satisfaction focused on benefit of consultation and accessibility of the outpatient clinic. Secondary outcomes included clinical variables of diabetes and use of staff resources. RESULTS We enrolled 357 outpatients (intervention, n = 178; control, n = 179). After 24 months, participants in the intervention group experienced more benefit from consultations compared with baseline within groups (P < 0.05) and fewer unnecessary visits compared with control subjects (P < 0.05). Patient needs covered and satisfaction with the outpatient clinic were high and unchanged in both groups, and accessibility was increased (three questions, all P < 0.05). A calculated 7-item patient satisfaction sum score favored the intervention group over control subjects (P < 0.001). There were no significant changes in glycated hemoglobin (HbA1c), LDL, blood pressure, and complication status. The mean number of outpatient visits over 24 months (± SD) was lower in the intervention group compared with control subjects (4.4 ± 2.8 vs. 6.3 ± 2.7; P < 0.001), while the number of telephone contacts was higher (3.1 ±3.4 vs. 2.5 ± 3.2; P < 0.001). CONCLUSIONS Patient satisfaction remained high or improved with patient-initiated on-demand use of the diabetes outpatient clinic, with no decline in the quality of diabetes care, and a reduction in the use of staff resources.