An evaluation of the impact of a data driven, individualised, diabetes specific, structured information delivered by mail to people with diabetes : the WICKED (Wolverhampton Interface Care-Knowledge Empowered Diabetes) Project

Abstract

Background Does promoting patient activation improve outcomes? We tested the hypothesis that provision of structured and personalised information can activate patients, promote selfcare, and improve outcomes. Methods We recruited all eligible people with diabetes in Wolverhampton CCG (n= 14,559), randomizing them into two groups. The active group was mailed their “My diabetes, My information, My plan” report at baseline, 3 and 6 months; the control group received standard care for first 3 months, then a single mailing. We compared a Failed Process Score (FPS = completion of nine processes; zero = full attainment) and HbA1c. A patient feedback survey was sent to 1000 randomly selected patients from the active cohort to assess the qualitative impact of this individualised report. Results At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in the active group. At 12 months FPS score between group differences just failed overall significance (F=3.459, p=0.06). However, in those with lower baseline activation (FPS of ≥2), FPS was significantly better (F=4.369, p=0.037, 3 month (p<0.01), 12 month (p=0.01)) in the multi mailed and their likelihood of achieving the good attainment category (12 month FPS ≤1) with mailing was 1.15 (95% CI 1.02 – 1.29, p=0.022). Considering baseline HbA1c% categories as ≤7.5, 7.6-8.4 and ≥8.5, and adjusting for variables in univariate analysis (r2=0.39, p<0.001; age p<0.001, gender (ns), ethnicity (ns), IMD score (ns), type of diabetes (ns)), the impact of being mailed multiple times was significant (F= 6.2, p=0.013).In the patient feedback survey, patients found this report useful (89%), a source of knowledge (78%) and confidence (74%) and it helped them in understanding their diabetes (78%). Conclusion The provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes