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).
<p> </p>
<p>Research Design
and Methods: A 24-month
randomized controlled trial, where 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 7 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.</p>
<p> </p>
<p>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 to baseline
within groups (p<0.05) and fewer unnecessary visits
compared to controls (p<0.05). Patient needs covered and satisfaction
with the outpatient clinic was high and unchanged in both groups, and accessibility
was increased (3 questions, all p<0.05). A calculated 7-item patient
satisfaction sum score favored the intervention group over controls
(p<0.001). There were
no significant changes in HbA1c, LDL, blood pressure, and complication status.
The mean number of outpatient visits over 24 months (±SD) was lower in the
intervention group compared to controls (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).</p>
<p> </p>
<p>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.</p>
Commonly Measured Clinical Variables Are Not Associated With Burden of Complications in Long-standing Type 1 Diabetes: Results From the Canadian Study of Longevity in Diabetes