Shared care for diabetes: supporting communication between primary and secondary care

Objective: To assess the effects on information exchange of electronic communication between physicians co-treating diabetic patients. Design: Comparison of traditional paper-based communication for reporting and electronic communication. Setting: General practitioners and an internal medicine outpatient clinic of an urban public hospital. Subjects: A total of 275 diabetic patients, and the 32 general practitioners and one internal medicine consultant who cared for them. Intervention: An electronic communication network; linking up the computer-based patient records of the physicians, thus enabling electronic data interchange. Main outcome measures: Number of letters sent and received per year by the general practitioners, the number of diabetes-related parameters (e.g. results of laboratory tests) in the patient records, and HBA1C levels. Results: Intervention GPs received more messages per year (1.6 per patient) than control GPs (0.5 per patient, P < 0.05). Significant higher availability (P < 0.05) was achieved for data on HBA1C levels, fructosamine levels, blood pressure measurements, cholesterol levels, triglyceride levels and weight measurements. Intervention patients showed a slight but significant decrease of HBA1C levels in the second semester of 1994 (from 7.0 to 6.8, P = 0.03), control patients also showed a slightly decreased group mean, but this change was not significant (from 6.6 to 6.5, P = 0.52). The magnitudes of these mean differences, however, were not significantly different (intervention group: 0.21; control group: 0.12, P = 0.68). Conclusions: The electronic communication network for exchanging consultation outcomes significantly increased frequency of communication and the availability of data to the general practitioner on diagnostic procedures performed in the hospital, thus providing more complete information about the care that patients are receiving. A large-scale experiment over a longer period of time is needed to assess the effects of improved communication on quality of care. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.