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Using Direct-to-Patient Technology and Clinical Decision Support to Increase Type 2 Diabetes Screening

Using Direct-to-Patient Technology and Clinical Decision Support to Increase Type 2 Diabetes Screening

A low-cost, novel direct-to-patient CDS tool that identifies patients at high risk of type 2 diabetes and offers them a screening test could increase the number of patients screened and save physicians’ time.

Identifying patients with elevated blood glucose levels

Type 2 diabetes (T2D) and pre-diabetes are significant public health problems. Characterized by elevated blood glucose levels, T2D and pre-diabetes, with the resulting complications that occur when untreated, can result in significant medical costs. Those at risk for T2D may be screened with serum hemoglobin A1C (HbA1c) testing, which reflects a patient’s average blood glucose level over the prior 3 months. Despite current screening guidelines, many high-risk patients do not get screened, contributing to approximately a quarter of T2D cases going undiagnosed. To assist physicians in identifying patients at risk, Dr. Brian Wells and his Wake Forest research team previously developed an HbA1c risk calculator for predicting which patients without previous symptoms of diabetes or hyperglycemia would have an elevated HbA1c. One method to increase screening is to alert providers when patients are at risk as identified by the risk calculator.

In primary care, one of the best things that we can do to improve patient outcomes is identify and manage chronic conditions early.”
- Dr. Wells

Offering screening to patients through text messaging

However, as a family physician Dr. Wells understands that busy PCPs may experience “alert fatigue” from alerts such as these. As such, he and his research team are developing a direct-to-patient CDS tool to identify at-risk patients and directly offer them screening. The tool will access patient data in the EHR and identify patients at risk using characteristics validated in the calculator. Once a patient is identified, they will receive a text message offering them testing through their primary care physician’s office. If the patient agrees to the screening, a lab order will be automatically placed. Results from the screening will be sent to both the patient and the patient’s physician.

Changing the way services are delivered

Using direct-to-patient technology is a novel strategy for reaching patients for screening recommendations. Dr. Wells thinks that by bypassing the clinician, more patients with be screened; those identified as hyperglycemic will be offered earlier treatment and thus better outcomes. Dr. Wells hopes that by “going directly to the patient and empowering them to get screened” the tool will help reconnect high-risk patients to the healthcare system. This low-cost, low-risk tool has the potential to be adapted for use with other chronic health conditions.