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Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial

Thamer A Alsulaiman, Intisar M Fadlallah, Hejab A Al-Ajmi.

Abstract
Background: Structured and regular review of patients with diabetes has shown to be effective in improving the process of their care. However, a register-recall system that periodically identifies patients not meeting their treatment targets and actively recalls them for review is not widely implemented in Saudi primary care clinics.

Objectives: To examine whether using a register-recall system in a primary care setting will result in improvement in glycemic control among patients with poorly controlled diabetes.

Materials and Methods: In this open-labeled prospective trial, two out of eleven primary care clinics at King Abdul-Aziz housing city, with closely matched demographics, were identified and cluster-randomized to receive intervention (register-recall) versus control (routine care) during the month of August 2015. One hundred and twenty eight patients with uncontrolled diabetes (glycated hemoglobin [A1c] ≥ 7.5%) were identified in both clinics and patients were then followed up for 6 months. A1c, blood pressure (BP), and low-density lipoprotein (LDL) were noted at baseline, 3 months and the end of the trial.

Results: Modest improvements in glycemic control were achieved among the intervention group at 6 months (mean difference [MD] = 0.44, 95% confidence interval [CI] = 1.06-0.18, P = 0.16). The odds of having uncontrolled diabetes (A1c ≥ 7.5%) among the intervention group was less than the control group (odds ratio [OR] = 0.24, 95% CI = 0.03-2.19, P = 0.37). Significant improvement in systolic blood pressure (SBP) (MD = 7, 95% CI= −12.7 to −1.3, P = 0.015) was noted at 6 months, while changes in LDL levels were marginal (MD = 0.1, 95% CI = −0.23- 0.43, P = 0.55). Except for SBP, none of the observed results quite reached statistical significance.

Conclusion: Modest, statistically insignificant, glycemic improvements were observed in this trial, while significant SBP improvement was achieved. The role of register-recall is unclear when dealing with very poorly controlled disease (A1c ≥ 10.5%).

Key words: Register-recall; Diabetes; Primary Care; Saudi Arabia


 
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How to Cite this Article
Pubmed Style

Alsulaiman TA, Fadlallah IM, Al-Ajmi HA. Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. Int J Med Sci Public Health. 2017; 6(8): 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



Web Style

Alsulaiman TA, Fadlallah IM, Al-Ajmi HA. Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. www.scopemed.org/?mno=267906 [Access: August 21, 2017]. doi:10.5455/ijmsph.2017.0514808062017



AMA (American Medical Association) Style

Alsulaiman TA, Fadlallah IM, Al-Ajmi HA. Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. Int J Med Sci Public Health. 2017; 6(8): 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



Vancouver/ICMJE Style

Alsulaiman TA, Fadlallah IM, Al-Ajmi HA. Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. Int J Med Sci Public Health. (2017), [cited August 21, 2017]; 6(8): 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



Harvard Style

Alsulaiman, T. A., Fadlallah, I. M. & Al-Ajmi, H. A. (2017) Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. Int J Med Sci Public Health, 6 (8), 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



Turabian Style

Alsulaiman, Thamer A, Intisar M Fadlallah, and Hejab A Al-Ajmi. 2017. Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. International Journal of Medical Science and Public Health , 6 (8), 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



Chicago Style

Alsulaiman, Thamer A, Intisar M Fadlallah, and Hejab A Al-Ajmi. "Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial." International Journal of Medical Science and Public Health 6 (2017), 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



MLA (The Modern Language Association) Style

Alsulaiman, Thamer A, Intisar M Fadlallah, and Hejab A Al-Ajmi. "Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial." International Journal of Medical Science and Public Health 6.8 (2017), 1292-1296. Print. doi:10.5455/ijmsph.2017.0514808062017



APA (American Psychological Association) Style

Alsulaiman, T. A., Fadlallah, I. M. & Al-Ajmi, H. A. (2017) Using a register-recall system in primary care for patients with poorly controlled diabetes; a cluster-randomized trial. International Journal of Medical Science and Public Health , 6 (8), 1292-1296. doi:10.5455/ijmsph.2017.0514808062017



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Retraction notice [Mar 02, 2015]
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