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Shiely F, O Shea N, Murphy E, Eustace J. Registry-based randomised controlled trials: conduct, advantages and challenges-a systematic review. Trials 2024; 25:375. [PMID: 38863017 PMCID: PMC11165819 DOI: 10.1186/s13063-024-08209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Registry-based randomised controlled trials (rRCTs) have been described as pragmatic studies utilising patient data embedded in large-scale registries to facilitate key clinical trial procedures including recruitment, randomisation and the collection of outcome data. Whilst the practice of utilising registries to support the conduct of randomised trials is increasing, the use of the registries within rRCTs is inconsistent. The purpose of this systematic review is to explore the conduct of rRCTs using a patient registry to facilitate trial recruitment and the collection of outcome data, and to discuss the advantages and challenges of rRCTs. METHODS A systematic search of the literature was conducted using five databases from inception to June 2020: PubMed, Embase (through Ovid), CINAHL, Scopus and the Cochrane Controlled Register of Trials (CENTRAL). The search strategy comprised of MESH terms and key words related to rRCTs. Study selection was performed independently by two reviewers. A risk of bias for each study was completed. A narrative synthesis was conducted. RESULTS A total 47,862 titles were screened and 24 rRCTs were included. Eleven rRCTs (45.8%) used more than one registry to facilitate trial conduct. Six rRCTs (25%) randomised participants via a specific randomisation module embedded within a registry. Recruitment ranged between 209 to 106,000 participants. Advantages of rRCTs are recruitment efficiency, shorter trial times, cost effectiveness, outcome data completeness, smaller carbon footprint, lower participant burden and the ability to conduct multiple trials from the same registry. Challenges are data collection/management, quality assurance issues and the timing of informed consent. CONCLUSIONS Optimising the design of rRCTs is dependent on the capabilities of the registry. New registries should be designed and existing registries reviewed to enable the conduct of rRCTs. At all times, data management and quality assurance of all registry data should be given key consideration. We suggest the inclusion of the term 'registry-based' in the title of all rRCT manuscripts and a clear simple breakdown of the registry-based conduct of the trial in the abstract to facilitate indexing in the major databases.
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Affiliation(s)
- Frances Shiely
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland.
- School of Public Health, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland.
| | - Niamh O Shea
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland
- Health Research Board, Trials Methodology Research Network, University College Cork, Cork, Ireland
| | - Ellen Murphy
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland
- Health Research Board, Trials Methodology Research Network, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
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Gonzalez JS, Hoogendoorn CJ, Schechter CB, Pappalardo L, Fernandez Galvis MA, Linnell J, Pham-Singer H, Walker EA, Wu WY. Outcomes of New York City Care Calls: A Prospective Randomized Controlled Effectiveness Trial of Telephone-Delivered Type 2 Diabetes Self-Management Support. Sci Diabetes Self Manag Care 2024; 50:235-249. [PMID: 38726912 DOI: 10.1177/26350106241245641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE The purpose of the 12-month randomized controlled trial was to evaluate the effectiveness of a Telephonic Self-Management Support (T-SMS) program among adults with type 2 diabetes (T2D). METHODS Eight hundred twelve adults with T2D participated in NYC Care Calls (mean age = 59.2, SD = 10.8; female = 57%; mean A1C = 9.3, SD = 1.8; Latino = 86%) and were randomly assigned to T-SMS or enhanced usual care (EUC). A1C (primary outcome), blood pressure, and body mass index (secondary outcomes) were extracted from electronic medical records. Secondary patient-reported outcomes, including depressive symptoms, diabetes distress, medication adherence, and self-management activities, were assessed by telephone in English or Spanish. For T-SMS, the number of assigned phone calls was based on baseline A1C, depressive symptoms, and/or diabetes distress. Analyses were conducted under the intention-to-treat principle. RESULTS A1C decreased over 12 months in both T-SMS (0.72% percentage points; 95% CI, 0.53-0.91) and EUC (0.66% percentage points; 95% CI, 0.46-0.85; Ps < .001). Diabetes distress and self-management also improved over time in both arms (Ps < .05). Compared to EUC, participants in the T-SMS arm did not differ in outcomes. CONCLUSIONS The T-SMS and EUC groups were found not to have an appreciable outcome difference. It is unclear whether improvements in A1C across both conditions represent a secular trend or indicate that print-based educational intervention may have a positive impact on self-management and well-being.
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Affiliation(s)
- Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York
| | - Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, New York
| | - Clyde B Schechter
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Lindsey Pappalardo
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | - Jill Linnell
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Hang Pham-Singer
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Elizabeth A Walker
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York
| | - Winfred Y Wu
- New York City Department of Health and Mental Hygiene, Long Island City, New York
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Gurcay B, Yilmaz FT, Bilgin A. The Effectiveness of Telehealth Interventions on Medication Adherence Among Patients with Type 2 Diabetes: A Meta-Analysis. Telemed J E Health 2024; 30:3-20. [PMID: 37219578 DOI: 10.1089/tmj.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Objective: Diabetes mellitus (DM) is a global health issue with an increasing frequency across the world and is an important disease in which medication adherence is a priority component for disease management. Several interventions are implemented to increase medication adherence in patients with type 2 DM, and telehealth interventions have become widespread thanks to technological advancements. This meta-analysis aims at reviewing the telehealth interventions applied to patients with type 2 DM and examining their effects on medication adherence. Methods: Relevant studies published in ScienceDirect, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed from 2000 to December 2022 were searched in this meta-analysis. Their methodological quality was assessed using the Modified Jadad scale. Total score for each study ranged from 0 (low quality) to 8 (high quality). Studies with four or more were of good quality. Standardized mean difference (SMD) and 95% confidence intervals (CI) were used for statistical analysis. Publication bias was assessed using the funnel plot and Egger regression test. Both subgroup analysis and meta-regression analysis were performed in the study. Results: A total of 18 studies were analyzed in this meta-analysis. All studies scored 4 or above in their methodological quality assessment and were of good quality. The combined results have shown that telehealth interventions significantly increased medication adherence in the intervention group (SMD = 0.501; 95% CI 0.231-0.771; Z = 3.63, p < 0.001). Our subgroup analysis has revealed that HbA1c value, mean age, and duration of intervention significantly affected the study results. Conclusion: Telehealth interventions are an effective method to increase medication adherence in patients with type 2 DM. It is recommended that telehealth interventions be expanded in clinical practices and included in disease management.
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Affiliation(s)
- Busra Gurcay
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Feride Taskin Yilmaz
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Aylin Bilgin
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
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Okpako T, Woodward A, Walters K, Davies N, Stevenson F, Nimmons D, Chew-Graham CA, Protheroe J, Armstrong M. Effectiveness of self-management interventions for long-term conditions in people experiencing socio-economic deprivation in high-income countries: a systematic review and meta-analysis. J Public Health (Oxf) 2023; 45:970-1041. [PMID: 37553102 PMCID: PMC10687879 DOI: 10.1093/pubmed/fdad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Long-term conditions (LTCs) are prevalent in socio-economically deprived populations. Self-management interventions can improve health outcomes, but socio-economically deprived groups have lower participation in them, with potentially lower effectiveness. This review explored whether self-management interventions delivered to people experiencing socio-economic deprivation improve outcomes. METHODS We searched databases up to November 2022 for randomized trials. We screened, extracted data and assessed the quality of these studies using Cochrane Risk of Bias 2 (RoB2). We narratively synthesized all studies and performed a meta-analysis on eligible articles. We assessed the certainty of evidence using GRADE for articles included in the meta-analysis. RESULTS The 51 studies included in this review had mixed findings. For the diabetes meta-analysis, there was a statistically significant pooled reduction in haemoglobin A1c (-0.29%). We had moderate certainty in the evidence. Thirty-eight of the study interventions had specific tailoring for socio-economically deprived populations, including adaptions for low literacy and financial incentives. Each intervention had an average of four self-management components. CONCLUSIONS Self-management interventions for socio-economically deprived populations show promise, though more evidence is needed. Our review suggests that the number of self-management components may not be important. With the increasing emphasis on self-management, to avoid exacerbating health inequalities, interventions should include tailoring for socio-economically deprived individuals.
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Affiliation(s)
- Tosan Okpako
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Abi Woodward
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | | | | | - Megan Armstrong
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
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Krause KR, Tay J, Douglas WA, Sammy A, Baba A, Goren K, Thombs BD, Howie AH, Oskoui M, Frøbert O, Trakadis Y, Little J, Potter BK, Butcher NJ, Offringa M. Paper II: thematic framework analysis of registry-based randomized controlled trials provided insights for designing trial ready registries. J Clin Epidemiol 2023; 159:330-343. [PMID: 37146660 DOI: 10.1016/j.jclinepi.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Registry-based randomized controlled trials (RRCTs) are increasingly used, promising to address challenges associated with traditional randomized controlled trials. We identified strengths and limitations reported in planned and completed RRCTs to inform future RRCTs. STUDY DESIGN AND SETTING We conducted an environmental scan of literature discussing conceptual or methodological strengths and limitations of using registries for trial design and conduct (n = 12), followed by an analysis of RRCT protocols (n = 13) and reports (n = 77) identified from a scoping review. Using framework analysis, we developed and refined a conceptual framework of RRCT-specific strengths and limitations. We mapped and interpreted strengths and limitations discussed by authors of RRCT articles using framework codes and quantified the frequencies at which these were mentioned. RESULTS Our conceptual framework identified six main RRCT strengths and four main RRCT limitations. Considering implications for RRCT conduct and design, we formulated ten recommendations for registry designers, administrators, and trialists planning future RRCTs. CONCLUSION Consideration and application of empirically underpinned recommendations for future registry design and trial conduct may help trialists utilize registries and RRCTs to their full potential.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4
| | - Joanne Tay
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - William A Douglas
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Adrian Sammy
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Katherine Goren
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, Quebec, Canada H3T 1E2; Departments of Psychiatry; Epidemiology, Biostatistics, and Occupational Health; Medicine; Psychology; and Biomedical Ethics Unit, McGill University, 845 Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Alison H Howie
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Maryam Oskoui
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, Quebec, Canada H3G 2M1
| | - Ole Frøbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Yannis Trakadis
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada H3G 1A4
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Nancy J Butcher
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada M5T 1R8
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, Ontario, Canada M5T 3M6; Division of Neonatology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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7
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Rauprich O, Möllenkamp M, Reimann J, Huster S, Schreyögg J, Marckmann G. [Effectiveness and Ethical Evaluation of Nudging to Promote the Self-Management in Diabetes Mellitus Type 2]. DAS GESUNDHEITSWESEN 2022; 84:1059-1066. [PMID: 35738300 PMCID: PMC9671667 DOI: 10.1055/a-1709-0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Nudges offer a wide range of options for protecting health in everyday life that supplements traditional public health measures. Against this background, we conducted initial investigations on the effectiveness and ethical aspects of different nudges for promoting self-management of patients with diabetes mellitus type 2 in the context of Disease Management Programs (DMPs). METHODS The ethical assessment of the nudges was done within the systematic framework of Marckmann et al. (2015) for public health ethics. The existing evidence on the effectiveness of nudges was summarised by means of a narrative literature review. RESULTS Target agreements with implementation plans, reminder, feedback reports, shared appointments of patients with physicians, peer mentoring, and behavior contracts are nudging interventions with moderate interference with personal rights and relatively unproblematic ethical requirements, which have demonstrated effectiveness in different contexts. Default enrollment for patient training courses, involvement of partners, confrontation with social norms, and shocking pictures may be effective as well; however, they interfere more deeply with the freedom and privacy of patients and, therefore, are bound to stronger ethical requirements and restrictions. The evidence base is still insufficient, especially for social support measures by relatives and peers. CONCLUSIONS Nudging offers a wide range of targeted interventions for supporting self-management of patients with chronic diseases, the potential of which has not yet been fully realized. Particularly promising interventions should be tested in pilot studies for their acceptance, effectiveness and cost-effectiveness in the context of DMPs.
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Affiliation(s)
- Oliver Rauprich
- Institut für Ethik, Geschichte und Theorie der Medizin,
Ludwig-Maximilians-Universität München, München,
Germany
| | - Meilin Möllenkamp
- Lehrstuhl für Management im Gesundheitswesen, Hamburg Center
for Health Economics, Universität Hamburg, Hamburg,
Germany
| | - Jennifer Reimann
- Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat
Bochum, Bochum, Germany
| | - Stefan Huster
- Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat
Bochum, Bochum, Germany
| | - Jonas Schreyögg
- Lehrstuhl für Management im Gesundheitswesen, Hamburg Center
for Health Economics, Universität Hamburg, Hamburg,
Germany
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin,
Ludwig-Maximilians-Universität München, München,
Germany
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Nadadur S. Medication Adherence App for Food Pantry Clients With Diabetes: A Feasibility Study. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Rookes TA, Barat A, Turner R, Taylor S. Reporting dose in complex self-management support interventions for long-term conditions: is it defined by researchers and received by participants? A systematic review. BMJ Open 2022; 12:e056532. [PMID: 35977763 PMCID: PMC9389087 DOI: 10.1136/bmjopen-2021-056532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The minimum clinically effective dose, and whether this is received in randomised controlled trials (RCTs) of complex self-management interventions in long-term conditions (LTCs), can be unclear. The Template for Intervention Description and Replication (TIDieR) checklist states that dose should be clearly reported to ensure validity and reliable implementation. OBJECTIVES To identify whether the expected minimum clinically effective dose, and the dose participants received is reported within research articles and if reporting has improved since the TIDieR checklist was published. METHODS Four databases were systematically searched (MEDLINE, PsycINFO, AMED and CINAHL) to identify published reports between 2008 and 2022 for RCTs investigating complex self-management interventions in LTCs. Data on reporting of dose were extracted and synthesised from the eligible articles. RESULTS 94 articles covering various LTCs including diabetes, stroke and arthritis were included. Most complex interventions involved behaviour change combined with education and/or exercise. The maximum dose was usually reported (n=90; 97.8%), but the expected minimum clinically effective dose and the dose received were reported in only 28 (30.4%) and 62 (67.4%) articles, respectively. Reporting of the expected minimum clinically effective dose and the dose participants received did not improve following the publication of the TIDieR checklist in 2014. CONCLUSIONS Interpreting results and implementing effective complex self-management interventions is difficult when researchers' reporting of dose is not in line with guidelines. If trial findings indicate benefit from the intervention, clear reporting of dose ensures reliable implementation to standard care. If the results are non-significant, detailed reporting enables better interpretation of results, that is, differentiating between poor implementation and lack of effectiveness. This ensures quality of interventions and validity and generalisability of trial findings. Therefore, wider adoption of reporting the TIDieR checklist dose aspects is strongly recommended. Alternatively, customised guidelines for reporting dose in complex self-management interventions could be developed. PROSPERO REGISTRATION NUMBER CRD42020180988.
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Affiliation(s)
| | - Atena Barat
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca Turner
- Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Stephanie Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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10
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Lee CS, Westland H, Faulkner KM, Iovino P, Thompson JH, Sexton J, Farry E, Jaarsma T, Riegel B. The effectiveness of self-care interventions in chronic illness: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2022; 134:104322. [DOI: 10.1016/j.ijnurstu.2022.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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11
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Telehealth Interventions to Improve Diabetes Management Among Black and Hispanic Patients: a Systematic Review and Meta-Analysis. J Racial Ethn Health Disparities 2022; 9:2375-2386. [PMID: 35000144 PMCID: PMC8742712 DOI: 10.1007/s40615-021-01174-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous systematic reviews have found that telehealth is an effective strategy for implementing interventions to improve glycemic control and other clinical outcomes for diabetes patients. However, these reviews have not meaningfully focused on Black and Hispanic patients-partly because of the lack of adequate representation of people from racial and ethnic minority groups in clinical trials. It is unclear whether telehealth interventions are effective at improving glycemic control among Black and Hispanic patients given the disproportionate number of barriers they face accessing health care. OBJECTIVES A systematic review and meta-analysis of randomized control trials that used telehealth interventions for improving glycemic control among Black and Hispanic diabetes patients. METHODS We reviewed PubMed, Embase, Web of Science, CINAHL, PsycINFO, and clinicalTrials.gov from inception to March 2021. We used a narrative summary approach to describe key study characteristics and graded the quality of studies using two reviewers. The pooled net change in HbA1c values was estimated across studies using a random-effects model. RESULTS We identified 10 studies that met our inclusion and exclusion criteria. Nine studies were included in the meta-analysis. Only one study was rated as having low bias. Telehealth interventions were primarily delivered by telephone calls, text messages, web-based portals, and virtual visits. Most interventions involved delivering diabetes self-management education. Telehealth intervention pooled across studies with a mix of Black and Hispanic participants (> 50% sample) was associated with a - 0.465 ([CI: - 0.648 to - 0.282], p = 0.000) reduction in HbA1c. CONCLUSIONS Our findings suggest telehealth interventions are effective at improving glycemic control among Black and Hispanic diabetes patients.
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12
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Impact of mobile health and telehealth technology on medication adherence of stroke patients: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Pharm 2021; 44:4-14. [PMID: 34800254 DOI: 10.1007/s11096-021-01351-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
Background Stroke patients have low medication adherence after discharge, which leads to a high recurrence rate and poor disease control. Various strategies have been explored to enhance medication adherence in this patient population. Aim To evaluate the effects of mobile health (mHealth) and telehealth technology on medication adherence in stroke patients. Method All English studies that met the inclusion criteria published before September 2021 were obtained from PubMed, EMBASE, Web of Science, and Cochrane Library. Two researchers independently screened articles, extracted data, and evaluated the quality of the included studies. All articles were about randomized controlled trials. Medication adherence was used as the outcome index of this review. Random or fixed-effect models were used in statistical methods. I2 statistics were used to evaluate heterogeneity. Results A total of ten studies met the inclusion criteria, covering 2151 stroke patients. Compared with the Usual Care group, the medication adherence scores of the mHealth technology group were better (standard mean deviation 0.67, 95% confidence interval, CI [0.49, 0.85], P < 0.001). The medication adherence ratio of the mHealth technology group was higher (odds ratio, OR, 2.81, 95% CI [1.35, 5.85], P = 0.006). Subgroup analysis showed that application and messaging interventions were more effective than the telephone call intervention (OR 4.05, 95% CI [2.10, 7.80], P < 0.001). The shorter the interval of the intervention, the better the medication adherence of patients (OR 4.24, 95% CI [2.30, 7.81], P < 0.001). Conclusion Compared with Usual Care, mHealth can effectively improve the medication adherence of stroke patients.
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13
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Mayberry LS, Nelson LA, Gonzalez JS. Adults with type 2 diabetes benefit from self-management support intervention regardless of depressive symptoms. J Diabetes Complications 2021; 35:108024. [PMID: 34521578 PMCID: PMC8511161 DOI: 10.1016/j.jdiacomp.2021.108024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023]
Abstract
AIMS Elevated depressive symptoms are common among adults with type 2 diabetes (T2D). In a secondary analysis from an RCT of a diabetes self-management support intervention that did not target depressive symptoms, we sought to determine if depressive symptoms were reduced by the intervention (i.e., depressive symptoms an outcome) or, alternatively, if intervention effects on hemoglobin A1c were lesser among persons with clinically elevated depressive symptoms (i.e., depressive symptoms an effect modifier). METHODS We evaluated a text messaging intervention, REACH, in a diverse (half non-white, half underinsured) sample of N = 506 adults with T2D. Participants completed the Patient Health Questionnaire-8 (PHQ) and A1c tests at baseline and 6 months. We conducted a factor analysis to identify somatic- and cognitive-affective symptoms on the PHQ. We tested our hypotheses with regression models, using interaction terms and subgroup analyses. RESULTS REACH improved depressive symptoms among participants with lower baseline A1c (<8.5%; β = -0.133, p = .007; cognitive β = -0.107, p = .038; somatic β = -0.131, p = .014) but not among participants with higher baseline A1c (≥8.5%; β = 0.040, p = .468). Baseline depressive symptoms did not modify the effect on A1c. CONCLUSIONS We found support for the hypothesis that depressive symptoms - both somatic- and cognitive-affective - may be an outcome, rather than an effect modifier, of effective diabetes self-management support interventions.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Center for Diabetes Translation Research, Nashville, TN, United States of America.
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Center for Diabetes Translation Research, Nashville, TN, United States of America
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States of America; Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America; New York Regional Center for Diabetes Translation Research, Bronx, NY, United States of America
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14
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Zocchi MS, Robinson SA, Ash AS, Vimalananda VG, Wolfe HL, Hogan TP, Connolly SL, Stewart MT, Am L, Netherton D, Shimada SL. Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. J Am Med Inform Assoc 2021; 28:2176-2183. [PMID: 34339500 DOI: 10.1093/jamia/ocab115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study sought to investigate whether consistent use of the Veterans Health Administration's My HealtheVet (MHV) online patient portal is associated with improvement in diabetes-related physiological measures among new portal users. MATERIALS AND METHODS We conducted a retrospective cohort study of new portal users with type 2 diabetes that registered for MHV between 2012 and 2016. We used random-effect linear regression models to examine associations between months of portal use in a year (consistency) and annual means of the physiological measures (hemoglobin A1c [HbA1c], low-density lipoproteins [LDLs], and blood pressure [BP]) in the first 3 years of portal use. RESULTS For patients with uncontrolled HbA1c, LDL, or BP at baseline, more months of portal use in a year was associated with greater improvement. Compared with 1 month of use, using the portal 12 months in a year was associated with annual declines in HbA1c of -0.41% (95% confidence interval [CI], -0.46% to -0.36%) and in LDL of -6.25 (95% CI, -7.15 to -5.36) mg/dL. Twelve months of portal use was associated with minimal improvements in BP: systolic BP of -1.01 (95% CI, -1.33 to -0.68) mm Hg and diastolic BP of -0.67 (95% CI, -0.85 to -0.49) mm Hg. All associations were smaller or not present for patients in control of these measures at baseline. CONCLUSIONS We found consistent use of the patient portal among new portal users to be associated with modest improvements in mean HbA1c and LDL for patients at increased risk at baseline. For patients with type 2 diabetes, self-management supported by online patient portals may help control HbA1c, LDL, and BP.
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Affiliation(s)
- Mark S Zocchi
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hill L Wolfe
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen T Stewart
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Linda Am
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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15
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Chen Y, Wei Y, Lang H, Xiao T, Hua Y, Li L, Wang J, Guo H, Ni C. Effects of a Goal-Oriented Intervention on Self-Management Behaviors and Self-Perceived Burden After Acute Stroke: A Randomized Controlled Trial. Front Neurol 2021; 12:650138. [PMID: 34354655 PMCID: PMC8329350 DOI: 10.3389/fneur.2021.650138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Stroke generates significant health and social burdens. Self-management has potential importance for supporting individuals in coping and continuing to progress after stroke. However, there is a lack of targeted programs to enhance self-management and reduce self-perceived burden (SPB) following stroke. Purpose: To evaluate the effects of a goal-oriented intervention on self-management behaviors and SPB among patients after acute stroke. Methods: This was a randomized controlled trial with a 4-weeks intervention. Participants were randomly allocated to the intervention (n = 48) or control group (n = 48). The intervention and control groups received eight sessions of goal-oriented self-management intervention based on Pender's health promotion model and control care, respectively. Self-management behaviors and SPB were evaluated and compared between the two groups. Results: After the 1-month follow-up, there were significant differences in the total self-management behaviors score and the scores of six of the self-management dimensions, excluding diet management, between the intervention group and the control group (t = −7.891– −2.815; p ≤ 0.006). Compared to the control group, the intervention group showed a significant decrease in the physical burden, emotional burden, and total SPB scores (t = 2.102–2.071; p = 0.015–0.041). The economic burden score was not significantly different between the two groups (t = 1.707; p = 0.091). Conclusion: The goal-oriented intervention based on Pender's health promotion model can effectively improve self-management behaviors and reduce physical and emotional SPB among stroke survivors.
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Affiliation(s)
- Yu Chen
- School of Nursing, Fourth Military Medical University, Xi'an, China
| | | | - Hongjuan Lang
- School of Nursing, Fourth Military Medical University, Xi'an, China
| | - Ting Xiao
- School of Nursing, Fourth Military Medical University, Xi'an, China
| | - Yan Hua
- School of Nursing, Fourth Military Medical University, Xi'an, China
| | - Lu Li
- College of Basic Medicne, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- School of Nursing, Fourth Military Medical University, Xi'an, China
| | - Hongxia Guo
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Chunping Ni
- School of Nursing, Fourth Military Medical University, Xi'an, China
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16
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The Effects of Telephone-Based Telenursing on Glycated Hemoglobin Among Older Adults With Type 2 Diabetes Mellitus: A Randomized Controlled Trial. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Chen Y, Ran X, Chen Y, Jiang K. Effects of Health Literacy Intervention on Health Literacy Level and Glucolipid Metabolism of Diabetic Patients in Mainland China: A Systematic Review and Meta-Analysis. J Diabetes Res 2021; 2021:1503446. [PMID: 35005027 PMCID: PMC8739182 DOI: 10.1155/2021/1503446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/06/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To systematically evaluate the effects of health literacy intervention on health literacy level and glycolipid metabolism of people with diabetes in mainland China. METHODS A systematic review of journal articles discussing diabetes and health literacy was performed by searching PubMed, Embase, the Science Citation Index Expanded (SCIE) database of Web of Science, the China National Knowledge Infrastructure (CNKI) database, the Chinese Scientific and Technical Journals database (CQVIP), and the Wanfang database. Cochrane Effective Practice and Organization of Care Review Group (EPOC) standards were applied for quality assessment. A meta-analysis was performed using Stata 12.0 software. RESULTS A total of 44 articles, including seven controlled before-and-after trials (CBAs), 27 randomized controlled trials (RCTs), and 10 nonrandomized controlled trials (non-RCTs), were included. The results showed that (1) health literacy level in the intervention group was improved compared with the preintervention and the control group; (2) fasting plasma glucose (FPG) (standardized mean difference (SMD) = -1.85, 95% CI: -2.28, -1.42), 2-hour plasma glucose (2hPG) (SMD = -2.18, 95% CI: -2.68, -1.68), and HbA1c (weighted mean difference (WMD) = -1.21, 95% CI: -1.48, -0.94) were significantly reduced in the intervention group; (3) total cholesterol (TC) (WMD = -0.43, 95% CI: -0.64, -0.23) was significantly reduced in the intervention group, although there were no statistically significant differences for triglycerides (TG) (WMD = -0.34, 95% CI: -0.73, 0.05), low-density lipoprotein cholesterol (LDL-C) (WMD = -0.20, 95% CI: -0.46, 0.07), or high-density lipoprotein cholesterol (HDL-C) (WMD = -0.06, 95% CI: -0.29, 0.17). CONCLUSION Intervention based on health literacy can effectively improve health literacy levels and reduce glucose metabolism and TC level among people with diabetes mellitus, although it has no significant effect on TG, LDL-C, or HDL-C.
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Affiliation(s)
- Yangli Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, China
| | - Xue Ran
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, China
| | - Yalan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, China
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18
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Gonzalez JS, Hoogendoorn CJ, Linnell J, Fishman S, Jonas V, Pham-Singer H, Schechter CB, Walker EA, Wu WY. Design and methods of NYC care calls: An effectiveness trial of telephone-delivered type 2 diabetes self-management support. Contemp Clin Trials 2020; 98:106166. [PMID: 33022367 DOI: 10.1016/j.cct.2020.106166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Although problems with type 2 diabetes (T2D) self-management and treatment adherence often co-occur with emotional distress, few translatable intervention approaches are available that can target these related problems in primary care practice settings. The New York City (NYC) Care Calls study is a randomized controlled trial that tests the effectiveness of structured support for diabetes self-management and distress management, delivered via telephone by health educators, in improving glycemic control, self-management and emotional well-being among predominantly ethnic minority and socioeconomically disadvantaged adults with suboptimally controlled T2D. English- and Spanish-speaking adults treated for T2D in NYC primary care practices were recruited based on having an A1C ≥ 7.5% despite being prescribed medications for diabetes. Participants (N = 812) were randomly assigned to a telephonic intervention condition with a stepped protocol of 6-12 phone calls over 1 year, delivered by a health educator, or to a comparison condition of enhanced usual care. The primary outcome is change in A1C over one year, measured at baseline and again approximately 6- and 12-months later. Secondary outcomes measured on the same schedule include blood pressure, patient-reported emotional distress, treatment adherence and self-management behaviors. A comprehensive effectiveness evaluation is guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) to gather data that can inform dissemination and implementation of the intervention, if successful. This paper describes the study rationale, trial design, and methodology.
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Affiliation(s)
- Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Jill Linnell
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Sarah Fishman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Victoria Jonas
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Hang Pham-Singer
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth A Walker
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Winfred Y Wu
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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19
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Güner TA, Coşansu G. The effect of diabetes education and short message service reminders on metabolic control and disease management in patients with type 2 diabetes mellitus. Prim Care Diabetes 2020; 14:482-487. [PMID: 32471770 DOI: 10.1016/j.pcd.2020.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/16/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
AIM The aim of this study was to evaluate the effect of diabetes education and short message service reminders on metabolic control and disease management in patients with type 2 diabetes mellitus who were registered in a family health center and who were using oral antidiabetics. METHODS This pre-test and post-test control group interventional study was conducted between 2017 and 2019. For one-way analysis of variance, effect size=0.40, α=0.05 and 80% power for each group was considered to be appropriate for 48 participants. Considering probability of losses during the study, 101 patients with type-2 DM were selected to include in the study. At the beginning of the study of all the patients, metabolic (HbA1c, FBS, triglycerides, cholesterol, HDL, LDL), anthropometric (BMI), blood pressure (BP) and scales assessments were performed. The Follow-Up Form for Patients with Diabetes, Diabetes Self-Care Scale (DSCS) and World Health Organization (WHO) (5) Goodness Scale were used as data collection tools. In the study, the structured group-based education program consisting of five modules was given to the intervention group in two sessions. Immediately after the education program, short message reminders about diabetes management were sent twice a week for a six-month period to intervention group. During the study, each group was invited to the family health center to perform the third- and sixth-month evaluations. Data were analyzed by SPSS version 19. In the study, categorical variables were evaluated with Chi-squared test. The differences of the groups over time were evaluated using the Friedman test and binary comparisons of differences by Wilcoxon test. The changes among groups over time were evaluated by Mann-Whitney test. RESULTS In the evaluations for the third and sixth months, it was found that there was a statistically significant difference between the intervention and control groups in terms of HbA1c, fasting blood sugar, lipid values (except triglycerides), blood pressure, body mass index and the scales results (p<0.001). CONCLUSION Diabetes education and SMS reminders sent for six months were effective in improving metabolic control and disease management in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Türkan Akyol Güner
- Faculty of Health Sciences, Department of Social Work, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
| | - Gülhan Coşansu
- Istanbul University Florance Nightingale Faculty of Nursing, Public Health Nursing Department, Istanbul, Turkey.
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20
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Mao Y, Lin W, Wen J, Chen G. Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001225. [PMID: 32988849 PMCID: PMC7523197 DOI: 10.1136/bmjdrc-2020-001225] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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21
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Tabaei BP, Howland RE, Gonzalez JS, Chamany S, Walker EA, Schechter CB, Wu WY. Impact of a Telephonic Intervention to Improve Diabetes Control on Health Care Utilization and Cost for Adults in South Bronx, New York. Diabetes Care 2020; 43:743-750. [PMID: 32132009 PMCID: PMC7085809 DOI: 10.2337/dc19-0954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 01/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention's impact in reducing health care utilization and costs over 4 years. RESEARCH DESIGN AND METHODS We measured inpatient (n = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm. RESULTS During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A1c during individuals' participation in the 1-year intervention. CONCLUSIONS These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.
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Affiliation(s)
- Bahman P Tabaei
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Renata E Howland
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Jeffrey S Gonzalez
- Albert Einstein College of Medicine, Bronx, NY.,New York Regional Center for Diabetes Translation Research, Bronx, NY.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Elizabeth A Walker
- Albert Einstein College of Medicine, Bronx, NY.,New York Regional Center for Diabetes Translation Research, Bronx, NY
| | - Clyde B Schechter
- Albert Einstein College of Medicine, Bronx, NY.,New York Regional Center for Diabetes Translation Research, Bronx, NY
| | - Winfred Y Wu
- New York City Department of Health and Mental Hygiene, New York, NY
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22
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Dawson AZ, Walker RJ, Campbell JA, Davidson TM, Egede LE. Telehealth and indigenous populations around the world: a systematic review on current modalities for physical and mental health. Mhealth 2020; 6:30. [PMID: 32632368 PMCID: PMC7327286 DOI: 10.21037/mhealth.2019.12.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
Approximately 370-500 million Indigenous people live worldwide. While Indigenous peoples make up only 5% of the world's population, they account for 15% of the extreme poor and have life expectancy that is 20 years shorter than that of non-Indigenous people. Access to healthcare has been identified as an important social determinant of health and key driver of health outcomes. Indigenous populations often face barriers to accessing healthcare including living in remote areas, lacking financial resources, and having cultural differences. Telehealth, the utililzation of any synchronous modality, including phone, video, or teleconferencing technology used to support the provision of long-distance health care and health education, is a feasible and cost-effective treatment delivery mechanism that has successfully addressed access barriers faced by vulnerable populations globally, however, few studies have included indigenous populations and the application of this technology to improve physical and mental health outcomes. This systematic review aims to identify trials that were conducted among Indigenous adults, and to summarize the components of interventions that have been found to effectively improve the health of Indigenous peoples. The PRISMA guidelines for reporting of systematic reviews were followed in preparing this manuscript. Studies were identified by searching PubMed, Scopus, and PsychInfo databases for clinical trial articles on Indigenous peoples and mental and physical health, published between January 1, 1998 and December 31, 2018. Eligibility criteria for determining studies to include in the analysis were as follows: (I) ≥18 years of age; (II) indigenous peoples; (III) any technology-based intervention; (IV) studies included at least one of the following mental health (depression, post-traumatic stress disorder, suicide) and physical health (mortality, blood pressure, hemoglobin A1C, cholesterol, quality of life) outcomes; (V) clinical trials. A total of 2,662 articles were identified and six were included in the final review based on pre-specified eligibility criteria. Three were conducted in the United States, one study was conducted in Canada, and two were conducted in New Zealand. Study sample sizes ranged from 20 to 762, intervention delivery times ranged from three to 20 months and utilized telephone, internet and SMS messaging as the type of technology. There is a paucity of evidence on the use of telehealth programs to increase access to chronic disease programs in Indigenous populations. This review highlights the importance of culturally tailoring programs despite the modality in which they are delivered, and recommends telephone-based delivery facilitated by a trained health professional. Telehealth has great promise for meeting the health needs of highly marginalized Indigenous populations around the world, however, at this point more research is needed to understand how best to structure and deliver these programs for maximum effect.
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Affiliation(s)
- Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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23
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Möllenkamp M, Zeppernick M, Schreyögg J. The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review. Health Policy 2019; 123:1199-1209. [PMID: 31676042 DOI: 10.1016/j.healthpol.2019.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022]
Abstract
In this systematic literature review, we identify evidence on the effectiveness of nudges in improving the self-management of adults with chronic diseases and derive policy recommendations. We included empirical studies of any design published up to April 12th, 2018. We synthesized the results of the studies narratively by comparing statistical significance and direction of different nudge types' effects on primary study outcomes. Lastly, we categorized the nudges according to their degree of manipulation and transparency. We identified 26 studies, where 13 were of high or moderate quality. The most commonly tested nudges were reminders, planning prompts, small financial incentives, and feedback. Overall, 8 of 9 studies with a high or moderate quality ranking, focused on self-management outcomes, i.e., physical activity, attendance, self-monitoring, and medication adherence, found that nudges had significant positive effects. However, only 1 of 4 studies of high or moderate quality, analyzing disease control outcomes (e.g., glycemic control), found that nudges had a significant positive effect for one intervention arm. In summary, this review demonstrates that nudges can improve chronic disease self-management, but there is hardly any evidence to date that these interventions lead to improved disease control. Reminders, feedback, and planning prompts appear to improve chronic disease self-management most consistently and are among the least controversial types of nudges. Accordingly, they can generally be recommended to policymakers.
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Affiliation(s)
- Meilin Möllenkamp
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
| | - Maike Zeppernick
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
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24
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Dethlefs HJ, Walker EA, Schechter CB, Dowd R, Filipi L, Garcia JF, Filipi C. Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic. Diabetes Res Clin Pract 2019; 148:212-221. [PMID: 30641164 PMCID: PMC6394404 DOI: 10.1016/j.diabres.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
AIMS To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. METHODS Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. RESULTS 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m2, HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. CONCLUSIONS Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
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Affiliation(s)
- Henry J Dethlefs
- One World Community Health Centers, Inc, 4920 S 30th St. Suite 103, Omaha, NE 68107, USA
| | - Elizabeth A Walker
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Clyde B Schechter
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Rachel Dowd
- CHI Creighton University Medical Center, 7500 Mercy Rd., Omaha, NE 68124, USA
| | - Linda Filipi
- Chronic Care International, 12370 Rose Lane, Omaha, NE 68154, USA
| | | | - Charles Filipi
- Creighton University, School of Medicine, Education Building, Suite 105, 7710 Mercy Road, Omaha, NE 68124, USA
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Wu C, Wu Z, Yang L, Zhu W, Zhang M, Zhu Q, Chen X, Pan Y. Evaluation of the clinical outcomes of telehealth for managing diabetes: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2018; 97:e12962. [PMID: 30412116 PMCID: PMC6221638 DOI: 10.1097/md.0000000000012962] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The objective of this study was to systematically review the literature and perform a meta-analysis comparing the clinical outcomes of telehealth and usual care in the management of diabetes. METHODS Multiple strategies, including database searches (MEDLINE, PsycINFO, PubMed, EMBASE, and CINAHL), searches of related journals and reference tracking, were employed to widely search publications from January 2005 to December 2017. The change in hemoglobin A1c (HbA1c) levels was assessed as the primary outcome, and changes in blood pressure, blood lipids, body mass index (BMI), and quality of life were examined as secondary outcomes. RESULTS Nineteen randomized controlled trials (n = 6294 participants) were selected. Telehealth was more effective than usual care in controlling the glycemic index in diabetes patients (weighted mean difference = -0.22%; 95% confidence intervals, -0.28 to -0.15; P < .001). This intervention showed promise in reducing systolic blood pressure levels (P < .001) and diastolic blood pressure levels (P < .001), while no benefits were observed in the control of BMI (P = .79). For total cholesterol and quality of life, telehealth was similar or superior to usual care. CONCLUSION Telehealth holds promise for improving the clinical effectiveness of diabetes management. Targeting patients with higher HbA1c (≥9%) levels and delivering more frequent intervention (at least 6 times 1 year) may achieve greater improvement.
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Affiliation(s)
- Cong Wu
- Department of Medical Quality Management, The Women's Hospital
| | - Zixiang Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingfei Yang
- Department of Medical Quality Management, The Women's Hospital
| | - Wenjun Zhu
- Department of Medical Quality Management, The Women's Hospital
| | - Meng Zhang
- Department of Medical Quality Management, The Women's Hospital
| | - Qian Zhu
- Department of Medical Quality Management, The Women's Hospital
| | - Xiaoying Chen
- Department of Medical Quality Management, The Women's Hospital
| | - Yongmiao Pan
- Department of Medical Quality Management, The Women's Hospital
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26
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Sherifali D, Berard LD, Gucciardi E, MacDonald B, MacNeill G. Self-Management Education and Support. Can J Diabetes 2018; 42 Suppl 1:S36-S41. [PMID: 29650109 DOI: 10.1016/j.jcjd.2017.10.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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Garg R, Hurwitz S, Rein R, Schuman B, Underwood P, Bhandari S. Effect of follow-up by a hospital diabetes care team on diabetes control at one year after discharge from the hospital. Diabetes Res Clin Pract 2017; 133:78-84. [PMID: 28898714 DOI: 10.1016/j.diabres.2017.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022]
Abstract
AIM This study was conducted to evaluate the effect of continued follow-up by a hospital diabetes team on HbA1c at 1-year after discharge. METHODS Adults with HbA1c ≥8% (64mmol/mol), undergoing an elective surgery, were treated in the perioperative period and randomized to continued care (CC) or the usual care (UC) after discharge. Patients in the CC group received weekly to monthly phone calls from a diabetes specialist nurse practitioner (NP) to review their home blood glucose values, diet, exercise, and medications. Patients in the UC group followed with their diabetes care providers. RESULTS Out of 151 patients, 77 were randomized to the CC group and 74 to the UC group. HbA1c (%) at 1-year was 8.2±1.4 in the CC group and 8.5±1.5 in the UC group (p=NS). Change in HbA1c from baseline was similar between the groups; -0.7±1.4 in the CC versus -0.7±1.5 in the UC group (p=NS). A higher number of calls was not associated with lower HbA1c or reduction in HbA1c. There were 41 insulin-treated patients in the CC group and 53 in the UC group and among them, HbA1c reduction was 0.5±1.5 and 0.6±1.3 respectively (p=NS). CONCLUSIONS Optimal perioperative treatment of diabetes is associated with an improvement in HbA1c but continued follow-up by a hospital diabetes team after discharge does not have an additional impact on long-term glycemic control. ClinicalTrials.gov identifier NCT02065050.
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Affiliation(s)
- Rajesh Garg
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Shelley Hurwitz
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Raquel Rein
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Brooke Schuman
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Patricia Underwood
- Veterans Health Administration, 150 South Huntington Avenue, Boston, MA 02130, United States
| | - Shreya Bhandari
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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28
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Advances in psychological interventions for lifestyle disorders: overview of interventions in cardiovascular disorder and type 2 diabetes mellitus. Curr Opin Psychiatry 2017; 30:346-351. [PMID: 28682800 DOI: 10.1097/yco.0000000000000348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The present review examines the recent advances in psychological interventions for two major lifestyle disorders in adults namely, type 2 diabetes mellitus and cardiovascular disorders. The review summarizes findings from studies carried out between the years 2015 and 2017. RECENT FINDINGS The effectiveness of psychological interventions in the management of lifestyle disorders has been examined with respect to adaptation, self-care, adherence, negative emotions and improving quality of life. There is an increasing recognition that psychological interventions are important for prevention of lifestyle disorders and promotion of health. Key psychological interventions include self-management and educational interventions based on learning and motivational principles, patient empowerment, cognitive behaviour therapy, behavioural skills and coaching. Recent developments also include the use of information technology to deliver these interventions through internet, mobile applications and text messages. Another significant development is that of mindfulness-based interventions within the third-generation behaviour therapy approaches to reduce distress and increase acceptance. In addition, family and couples interventions have also been emphasised as necessary in maintenance of healthy behaviours. SUMMARY Studies examining psychological interventions in cardiovascular and type 2 diabetes mellitus support the efficacy of these interventions in bringing about changes in biochemical / physiological parameters and in psychological outcomes such as self-efficacy, knowledge, quality of life and a sense of empowerment.
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Abstract
PURPOSE OF REVIEW Multi-sector partnerships are broadly considered to be of value for diabetes prevention and management. The purpose of this article is to summarize academic and government collaborations focused on diabetes prevention and management. RECENT FINDINGS Using a narrative review approach, we identified 17 articles describing 10 academic and government partnerships for diabetes management and surveillance. Challenges and gaps in the literature include complexity of diabetes management vis a vis current healthcare infrastructure; a paucity of racial/ethnic diversity in translational efforts; and the time/effort needed to maintain strong relationships across partner institutions. Academic and government partnerships are of value for diabetes prevention and management activities. Acknowledgment that the key priorities of government programming are often costs and feasibility is critical for collaborations to be successful. Future translational efforts of diabetes prevention and management programs should focus on the following: (1) expansion of partnerships between academia and local health departments; (2) increased utilization of implementation science for enhanced and efficient implementation and dissemination; and (3) harnessing of technological advances for data analysis, patient communication, and report generation.
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Affiliation(s)
- Stella S Yi
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA.
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, Division of Primary Care and Prevention, New York, NY, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA
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30
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Moreira AM, Marobin R, Rados DV, de Farias CB, Coelli S, Bernardi BL, Faller LDA, Dos Santos LF, Matzenbacher AM, Katz N, Harzheim E, Silveiro SP. Effects of nurse telesupport on transition between specialized and primary care in diabetic patients: study protocol for a randomized controlled trial. Trials 2017; 18:222. [PMID: 28521796 PMCID: PMC5437415 DOI: 10.1186/s13063-017-1954-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background According to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics. Methods We designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up. Discussion We plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care. Trial registration Clinical Trials, NCT02768480. Registered on 29 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1954-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana Marina Moreira
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 4 andar, Porto Alegre, RS, CEP 90035-903, Brazil.
| | - Roberta Marobin
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Bergonsi de Farias
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sabrina Coelli
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Bárbara Luiza Bernardi
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | | | - Natan Katz
- Division of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Erno Harzheim
- Division of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra Pinho Silveiro
- Post Graduate Program in Medical Sciences - Division of Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Nelson K, Taylor L, Silverman J, Kiefer M, Hebert P, Lessler D, Krieger J. Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014. Prev Chronic Dis 2017; 14:E15. [PMID: 28182863 PMCID: PMC5303652 DOI: 10.5888/pcd14.160344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Community health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes. Methods Low-income patients with glycated hemoglobin A1c (HbA1c) of 8.0% or higher in the 12 months before enrollment from 3 safety-net providers were randomized to a 12-month CHW-delivered diabetes self-management intervention or usual care. CHWs were based at a local health department. The primary outcome was change in HbA1c from baseline enrollment to 12 months; secondary outcomes included blood pressure and lipid levels, quality of life, and health care use. Results The change in HbA1c in the intervention group (n = 145) (unadjusted mean of 9.09% to 8.58%, change of −0.51) compared with the control group (n = 142) (9.04% to 8.71%, change of −0.33) was not significant (P = .54). In an analysis of participants with poor glycemic control (HbA1c >10%), the intervention group had a 1.23-point greater decrease in HbA1c compared with controls (P = .046). For the entire study population, we found a decrease in reported physician visits (P < .001) and no improvement in health-related quality of life (P = .07) in the intervention group compared with the control group. Conclusion A low-intensity CHW-delivered intervention to support diabetes self-management did not significantly improve HbA1c relative to usual care. Among the subgroup of participants with poor glycemic control (HbA1c >10% at baseline), the intervention was effective.
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Affiliation(s)
- Karin Nelson
- VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.,University of Washington, School of Medicine, Seattle, Washington.,University of Washington, School of Public Health, Seattle, Washington
| | - Leslie Taylor
- VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Julie Silverman
- VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.,University of Washington, School of Medicine, Seattle, Washington
| | - Meghan Kiefer
- VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.,University of Washington, School of Medicine, Seattle, Washington
| | - Paul Hebert
- VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,University of Washington, School of Medicine, Seattle, Washington
| | - Dan Lessler
- University of Washington, School of Medicine, Seattle, Washington
| | - James Krieger
- University of Washington, School of Medicine, Seattle, Washington.,University of Washington, School of Public Health, Seattle, Washington.,Public Health - Seattle and King County, Seattle, Washington
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Trief PM, Fisher L, Sandberg J, Cibula DA, Dimmock J, Hessler DM, Forken P, Weinstock RS. Health and Psychosocial Outcomes of a Telephonic Couples Behavior Change Intervention in Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial. Diabetes Care 2016; 39:2165-2173. [PMID: 27456837 PMCID: PMC5127234 DOI: 10.2337/dc16-0035] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare glycemic control and secondary outcomes of a 4-month telephonic couples behavioral intervention to individual intervention, and to education, for adults with type 2 diabetes. RESEARCH DESIGN AND METHODS A randomized trial with the following three arms: couples calls (CC) (n = 104); individual calls (IC) (n = 94); and diabetes education (DE) (n = 82). All arms had self-management education (two calls). CC and IC had 10 additional behavior change calls. CC addressed collaboration and relationships/communication. Participants consisted of 280 couples, among whom one partner had type 2 diabetes and an A1C level ≥7.5%. Blinded assessments occurred at 4, 8, and 12 months. The primary outcome was change in A1C; and secondary outcomes were BMI, waist circumference, blood pressure, depressive symptoms, diabetes self-efficacy, and diabetes distress. RESULTS Patients had a mean age of 56.8 years; 61.6% were male, and 30.4% were minorities. The baseline mean A1C level was 9.1%. Intention-to-treat analyses found significant A1C reductions for all (12 months: CC -0.47%, IC -0.52%, DE -0.57%), with no differences between arms. Preplanned within-arm analyses were stratified by baseline A1C tertiles: lowest tertile (7.5-8.2%), no change from baseline; middle tertile (8.3-9.2%), only CC led to significantly lower A1C level; and highest tertile (≥9.3%), significant improvement for all interventions. For BMI, CC showed significant improvement, and CC and DE led to decreased waist circumference. The IC group showed greater blood pressure improvement. Results for secondary psychosocial outcomes favored the CC group. CONCLUSIONS In adults with poorly controlled type 2 diabetes, a collaborative couples intervention resulted in significant, lasting improvement in A1C levels, obesity measures, and some psychosocial outcomes. For those with exceedingly high A1C levels, education alone was beneficial, but additional intervention is needed to achieve glycemic targets.
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Affiliation(s)
- Paula M Trief
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY .,Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY
| | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Donald A Cibula
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, NY
| | - Jacqueline Dimmock
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY
| | - Danielle M Hessler
- Department of Family Medicine, University of California, San Francisco, San Francisco, CA
| | - Patricia Forken
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY
| | - Ruth S Weinstock
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY
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Blankshain KD, Moss HE. Research Registries: A Tool to Advance Understanding of Rare Neuro-Ophthalmic Diseases. J Neuroophthalmol 2016; 36:317-23. [PMID: 27389624 PMCID: PMC4988906 DOI: 10.1097/wno.0000000000000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical research registries (MRR) are organized systems used to collect, store, and analyze patient information. They are important tools for medical research with particular application to the study of rare diseases, including those seen in neuro-ophthalmic practice. EVIDENCE ACQUISITION Evidence for this review was gathered from the writers' experiences creating a comprehensive neuro-ophthalmology registry and review of the literature. RESULTS MRR are typically observational and prospective databases of de-identified patient information. The structure is flexible and can accommodate a focus on specific diseases or treatments, surveillance of patient populations, physician quality improvement, or recruitment for future studies. They are particularly useful for the study of rare diseases. They can be integrated into the hierarchy of medical research at many levels provided their construction is well organized and they have several key characteristics including an easily manipulated database, comprehensive information on carefully selected patients, and comply with human subjects regulations. MRR pertinent to neuro-ophthalmology include the University of Illinois at Chicago neuro-ophthalmology registry, Susac Syndrome Registry, Intracranial Hypertension Registry, and larger-scale patient outcome registries being developed by professional societies. CONCLUSION MRR have a variety of forms and applications. With careful planning and clear goals, they are flexible and powerful research tools that can support multiple different study designs, and this can provide the potential to advance understanding and care of neuro-ophthalmic diseases.
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Affiliation(s)
- Kimberly D Blankshain
- Rosalind Franklin University of Medicine and Science, Chicago Medical School
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago
| | - Heather E Moss
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago
- Department of Neurology and Rehabilitation, University of Illinois at Chicago
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Wan LH, Zhang XP, Mo MM, Xiong XN, Ou CL, You LM, Chen SX, Zhang M. Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2016; 25:2259-70. [PMID: 27371106 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/01/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. METHODS This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of predischarge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. RESULTS Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. CONCLUSIONS Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets.
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Affiliation(s)
- Li-Hong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Pei Zhang
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Miao-Miao Mo
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xiao-Ni Xiong
- Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cui-Ling Ou
- Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Ming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Shao-Xian Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Min Zhang
- Department of Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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Ruddock JS, Poindexter M, Gary-Webb TL, Walker EA, Davis NJ. Innovative strategies to improve diabetes outcomes in disadvantaged populations. Diabet Med 2016; 33:723-33. [PMID: 27194172 DOI: 10.1111/dme.13088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/02/2016] [Indexed: 12/15/2022]
Abstract
Diabetes disproportionately affects disadvantaged populations. Eighty percent of deaths directly caused by diabetes occurred in low- and middle-income countries. In high-income countries, there are marked disparities in diabetes control among racial/ethnic minorities and those with low socio-economic status. Innovative, effective and cost-effective strategies are needed to improve diabetes outcomes in these populations. Technological advances, peer educators and community health workers have expanded methodologies to reach, educate and monitor individuals with diabetes. In the present manuscript we review the outcomes of these strategies, and describe the barriers to and facilitators of these approaches for improving diabetes outcomes.
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Affiliation(s)
- J S Ruddock
- Department of Medicine, North Central Bronx Hospital, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - M Poindexter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
| | - T L Gary-Webb
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
| | - E A Walker
- Department of Medicine, North Central Bronx Hospital, Bronx, NY
| | - N J Davis
- Department of Medicine, North Central Bronx Hospital, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Swoboda CM, Miller CK, Wills CE. Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes. DIABETES EDUCATOR 2016; 42:429-43. [DOI: 10.1177/0145721716650043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). Methods A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity–related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. Results From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). Conclusion A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes.
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Affiliation(s)
- Christine M. Swoboda
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
| | - Carla K. Miller
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
| | - Celia E. Wills
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
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37
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Schechter CB, Walker EA, Ortega FM, Chamany S, Silver LD. Costs and effects of a telephonic diabetes self-management support intervention using health educators. J Diabetes Complications 2016; 30:300-5. [PMID: 26750743 PMCID: PMC4761277 DOI: 10.1016/j.jdiacomp.2015.11.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness. METHODS Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported. RESULTS The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators. CONCLUSIONS Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
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Affiliation(s)
| | | | - Felix M Ortega
- New York City Department of Health and Mental Hygiene, USA
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, USA
| | - Lynn D Silver
- New York City Department of Health and Mental Hygiene, USA
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