1. Visual Aid for Hemoglobin A1c Results in Primary Care: A Pilot Study
Sean A. Fiore, M.S., RN1; Rosemary Dale, Ed.D., APRN1,2; Margaret Aitken, D.N.P., APRN1,2
1University of Vermont College of Nursing and Health Sciences, 2Appletree Bay Primary Care
ABSTRACT
INTRODUCTION
RESULTS
DISCUSSION
Purpose: Visual aids are associated with improved numeracy, health literacy, and outcomes.
Methods: An electronic visual aid A1c “report card” was developed for pilot study in primary care. Patients were surveyed regarding their reaction to visual aids.
Results/Conclusion: Most patients would like to see visual aids for test results in the future. The majority found them useful, and those with abnormal A1c expressed intent to modify their behavior. Visual aids may inspire patients to consider behavioral changes such as increased exercise and improved diet. However, further study is needed to investigate whether patients do change behavior or A1c results improve in response to visual aid utilization.
Background
Numeracy is a common problem in the US
25% of general population with numeric reasoning deficits1
Lab test results often displayed in numeracy-ignorant tables
Low numeracy predicts low health literacy
Low health literacy associated with poorer outcomes
Access to health information on the rise
Required use of electronic health record (EHR)
Increasing use patient portal systems
Available information not portrayed with numeracy in mind
Visual aids proven to be efficacious1
Improved risk perception
Motivational
Purpose: To pilot a visual aid in a primary care setting for hemoglobin A1c test results.
Aims:
To highlight features that patients find helpful or unhelpful
To ascertain potential for motivation to change
To explore possibility of introducing new clinical teaching tool to primary care clinic
Population Characteristics
35 visual aid report cards sent, 17 survey responses
10 (59%) with type 2 diabetes mellitus (DMT2)
3 (30%) with DMT2 not at goal
3 (18%) with prediabetes
3 (100%) with prediabetes not at goal
4 (23%) with no diabetes or prediabetes
0 not at goal
Patient Perception of Visual Aid (n=17)
Well-described: 82%
Non-confusing: 82%
Useful: 65%
Would like to see again in the future: 94%
Motivational Intent
Content Analysis
Findings
Most patients found the visual aid for test results clear, non-confusing, and useful
Most patients are open to seeing visual aids used to deliver test results in the future
Results consistent with existing literature
Patients prefer visual aids over number tables2
Associated with desire to modify behaviors3
Lessons
Difficult to implement as additional program to existing EHR
Better if integrated into EHR software
More useful as educational tool during patient encounter
Limitations
Most patients in sample already at goal
Subjective desire to change
May not predict actual change
Risk for researcher bias
CONCLUSIONS
Patients largely appreciate clarity of test results presented with a visual aid
Visual aids may promote better patient understanding of test results and associated risks
EHR developers should consider utilizing visual aids
Especially for patients with access to results
Additional research will help confirm whether improved outcomes can be associated with visual aids
METHODS AND MATERIALS
Site: Local patient-centered medical home
Sample: Adults 18+ receiving A1c screening
Measures
Patient perception
Usefulness, confusing, descriptiveness, desire to see visual aid again in the future
Behavioral intent
Need for behavioral change, likeliness to change, type of changes necessary
Content analysis
Procedures
RN inputs A1c results into tool, A1c report card generated
Report card printed and mailed to patient
RN follow up 7-10 days via telephone
CONTACT
REFERENCES
Garciaia-Retamero, R., & Cokely, E. T. (2017). Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics. Hum Factors, 59(4), doi: /
Brewer, N. T., Gilkey, M. B., Lillie, S. E., Hesse, B. W., & Sheridan, S. L. (2012). Tables or bar graphs? Presenting test results in electronic medical records. Med Decis Making, 32(4), doi: / x
Zikmund-Fisher, B. J., Exe, N. L., & Witteman, H. O. (2014). Numeracy and literacy independently predict patients' ability to identify out-of-range test results. J Med Internet Res, 16(8), e187. doi: /jmir.3241
CONTACT
Sean A. Fiore
University of Vermont
College of Nursing and Health Sciences