Increasing diabetes testing adherence with incentives in rural Northwestern Ontario.

Introduction: The health outcomes of rural Canadians have been described as poor and can in some part be related to diabetes mellitus. Despite the high mortality and morbidity rates associated with the disease, compliance with management remains low. Research has shown that a small financial incentive used to modify patient behaviour, can improve outcomes in cardiac disease and exercise adherence. This study aims to evaluate if a small financial incentive awarded to rural Northwestern Ontario patients with diabetes who complete an haemoglobin A1c (HbA1c) test, would result in greater compliance in test completion. Methods: Patients were recruited through two Northern rural clinics. Participants were divided into two groups: Group A received a financial incentive, whereas Group B received a letter of reminder. HbA1c tests were recorded every 6 months for 2 years and compliance was analysed using a t-test and Chi-square. Results: One hundred and forty-six participants were recruited with 30 lost to follow-up. Overall, the incentive group completed a statistically significantly higher number of HbA1c tests compared to those in the control group. In addition, it was noted that there was an increase in test adherence for participants that received reminder letters, although not an initially expected outcome of the study. Conclusion: The results suggest that either a financial incentive or a reminder directed towards rural Canadians could have a benefit in promoting health behaviours to subsequent medical management of diabetes mellitus.

Résumé Introduction: Les résultats en matière de santé des Canadiennes et Canadiens vivant en milieu rural ont été décrits comme médiocres et peuvent en partie être liés au diabète sucré. Malgré les taux élevés de mortalité et de morbidité associés à cette maladie, l'observance du traitement reste faible. La recherche a montré qu'un petit incitatif financier utilisé pour modifier le comportement du patient, peut améliorer les résultats dans les maladies cardiaques et l'adhésion à l'exercice. Cette étude vise à évaluer si une petite incitation financière accordée aux patients diabétiques des régions rurales du nord-ouest de l'Ontario qui effectuent un test HbA1c, entraînerait une plus grande conformité dans l'exécution du test. Méthodes: Les patients ont été recrutés dans deux cliniques rurales du nord. Les participants ont été divisés en deux groupes: Le groupe A a reçu une incitation financière, tandis que le groupe B a reçu une lettre de rappel. Les tests HbA1c ont été enregistrés tous les 6 mois pendant 2 ans et la conformité a été analysée à l'aide d'un test t et d'un chi carré. Résultats: 146 participants ont été recrutés, dont 30 ont été perdus lors du suivi. Dans l'ensemble, le groupe incitatif a réalisé un nombre statistiquement significatif de tests d'HbA1c par rapport aux participants du groupe témoin. De plus, une augmentation de l'adhésion aux tests a été remarquée pour les participants qui ont reçu des lettres de rappel, bien que ce ne soit pas un résultat initial attendu de l'étude. Conclusion: Les résultats suggèrent que soit une incitation financière, soit un rappel destiné aux Canadiennes et Canadiens des zones rurales pourrait avoir un avantage dans la promotion des comportements de santé pour la gestion médicale ultérieure du diabète sucré. Mots-clés: Gestion du diabète sucré, incitation financière, médecine rurale, test HbA1c.

Management of infectious diseases in remote northwestern Ontario with telemedicine videoconference consultations.

Northwestern Ontario in Canada provides a unique clinical challenge for providing optimal medical care. It is a large geographic area (385,000 km2) and is home to 32 remote First Nations communities, most without road access. These communities suffer a heavy burden of infectious disease and specialist consultations are difficult to obtain. The Division of Infectious Diseases at the Ottawa Hospital and the Sioux Lookout Meno Ya Win Health Centre established a telemedicine-based infectious disease consultation service in July 2014. We describe the implementation of this service, types of cases seen and patient satisfaction, as well as some of the challenges encountered. Information on visits was prospectively collected through an administrative database, and patient satisfaction surveys were administered after each initial consultation. During our first year of operation, 191 teleconsultations occurred: 76 initial consultations, 82 follow-up appointments and 33 case conferences. The scope of cases has been broad, mostly involving musculoskeletal infections (26%), followed by skin and soft tissue infections (23%). HCV, acute rheumatic fever, and respiratory infections (including pulmonary tuberculosis) were other diagnoses. Patient satisfaction has been very high and 28 telemedicine patient visits have occurred in their remote home communities, minimizing travel. The infectious disease consulting service and local clinicians have succeeded in addressing needs for care in infectious diseases in northwestern Ontario, where important gaps in service to First Nations' communities continue to exist. Regular scheduled available access to an infectious disease specialist is a well-received advancement of care in this remote region of Canada.