Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Are You There? 2 Solutions for a Common OGTT Recruitment Breakdown

In OGTT Screening on November 9, 2010 at 4:23 PM

It’s been two weeks and Eva is making her third attempt to reach Sandra. Referred by her provider to get screened, Eva sits looking dejected in front of the referral note (click here for the OGTT recruitment write-up script).

Out of 20 referrals, Eva typically reaches five. The remaining 15 are unreachable – either not home or sporting a disconnected phone number. Eva leaves a message with those who have answering machines or someone capable of taking a message. Two or three will return her message. Now, what happens with the remaining 12 or 13 patients who were never spoken with after their provider wrote them an OGTT referral? Herein lies the rub.

A note is written on their referral form, and it is returned to the chart, filed away until the patients’ next scheduled PCP appointment. When is that appointment? Someday (indeed, elusive someday) in the future.

The problem with this scenario is not colossal: if the PCP has an urgent concern for the patient’s blood glucose level, they schedule an individual OGTT screening lab for that week as opposed to writing a group OGTT screening referral. An emergency, therefore, is not the problem. The main drawbacks of this system are as follows:

1) If the provider requests additional blood tests, like TSH, on that referral form, those requests are lost.

2) The elusive someday is truly elusive; for one reason or another the patient might not return to the clinic for years, by which time their prediabetes could easily have metamorphosed into type 2 diabetes.

A simple solution to this systems breakdown is to file the referral form into the referring providers’ folders after our Diabetes Prevention Program staff has finished with them, instead of into patients’ charts. Providers would then have the opportunity to see and, most importantly, react to the outcome of their referral request – whether that be to send a letter out themselves to those who were unreachable or note that the patient is scheduled for their screening.

Possible solution #2 is to attach a scheduling form to each referral form. In the moment that the provider chooses to refer the patient to a screening, a date and time would thereby be assigned. Both the scheduling and referral forms would get routed to the DPP office, and the DPP staff would take it from there, ensuring that the patient was set up to attend the screening.

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