HealthDay News — Electronic messaging and telephone reminders increase primary-care office visits in patients diagnosed with diabetes in the patient-centered medical home (PCMH) health care delivery system, according to researchers.

“Telephone- and Internet-based communication are increasingly common in primary care, yet there is uncertainty about how these forms of communication affect demand for in-person office visits,” wrote David T. Liss, PhD, of Northwestern University in Chicago, and colleagues in the Annals of Family Medicine.

To examine the correlation between use of copay-free secure messaging and telephone encounters and office visit use in patients with diabetes, investigators used an interrupted time series design with a patient-quarter unit of analysis. Data were collected for 18,486 patients with diabetes in three periods before, during, and after a PCMH redesign in an integrated health care delivery system.

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There was 28% increase in the mean quarterly number of primary-care contacts between the pre-PCMH redesign baseline and the post-implementation periods. The increase was due mainly to increased secure messaging.

An 8% decrease was noted in quarterly office visit use. A 10% increase in secure message threads and telephone encounters correlated with 1.25% and 2.74% increases in office visits, respectively, in adjusted analyses. For all study periods and patient subpopulations, proportional increases in secure messaging and telephone encounters remained associated with increased office visit use.

“Our findings provide evidence on how new forms of patient-clinician communication may affect demand for office visits,” wrote the researchers.


  1. Liss D et al. Annals of Family Medicine. 2014; doi: 10.1370/afm.1642