Prospective Calling for Spanish-Speaking Diabetic Patient Pilot to Improve Failed to Keep Appointment Rate


Lily T Nguyen, PharmD, BCPS, CDE; Erica T Chen, PharmD,
BCACP, CDE; Sue Colby, RN, BSN, MPA-HSA; Meena Pai, MD;
Annabelle Zabal, RN, BSN, CPC

Introduction: Disparity in health care, particularly diabetes control, continues to exist between the Spanish- and English-speaking populations. In 2016, there was a 7.5% disparity among patients who had an A1C less than 9% at Kaiser Permanente San Jose. One of the barriers that may contribute to this disparity is the 40% rate among Spanish-speaking patients with diabetes who failed to keep appointments (FTKA) with the bilingual diabetes pharmacist. In this study, we looked to see if prospective calling of these patients could help improve the FTKA rate by 20%.
Methods: Between August 24, 2016 and September 30, 2016, patients with appointments to discuss diabetes control with a Spanish-speaking diabetes pharmacist received an appointment reminder phone call from the bilingual program assistant one business day before the appointment. Patients who did not keep their appointments received follow-up phone calls to rebook the appointment and to identify patient-specific barriers that contributed to the missed appointment.
Results: The FTKA rate decreased to 18% after process implementation. Additionally, those who received a live call instead of a voicemail reminder had a 9% FTKA rate vs 29% for those who received a voicemail. Additionally, 6 weeks after the project ended, the number of patients with an A1C < 9% increased by 2%. Patient-reported barriers for missing their appointments were primarily related to work or family issues.
Discussion: Prospective calling appeared to decrease the FTKA rate, decrease time to A1C control, and increase access to the diabetes pharmacist. There were several keys to success including a direct line for patients to call, consistent staffing for prospective calling, and the establishment of a relationship between clinicians and patients. Further study is required to continue to evaluate other solutions.


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