Letter to the editor regarding Strauss et al.

Abstract

To the Editor:—I laud Strauss et al.1 for identifying driving distance as a system barrier to diabetes control. Such studies provide a renewed interest in alternatives to face-to-face visits. It is important to emphasize the potential value of telephone contacts and electronic linkages, as suggested by the authors. There is evidence that clinical outcomes can be enhanced for diabetes,2 hypertension,3 and depression4 and unscheduled visits can be decreased5 through telephone care contacts. In addition, a recent survey of diabetics indicated that over one-third of those queried were internet users.6 I do note, however, that only 1,576/4,209 (37%) of the potential subjects of Strauss's study could be reached by phone. Was the low number of those contacted the result of the lack of a telephone, follow-up attempts to call prospective research subjects, medical record administrative information, or some other reason? Having conducted a VA telephone care clinic from 2001 to 2003 solely to manage diabetes, hypertension, and hyperlipidemia,7 I rarely encountered a situation when a patient could not be reached by telephone despite the fact many were of lower financial socioeconomic status and resided in rural areas. I also wonder if those contacted in this study were queried about access to the internet.