Effects of Patient-Initiated Visits on Patient Satisfaction and Clinical Outcomes in a Type 1 Diabetes Outpatient Clinic: A 2-Year Randomized Controlled Study

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).

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.

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).

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.