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Fernandez J, Agarwal KS, Amspoker AB, Godwin KM, Green E, Pickens S, Lindo J, Asghar-Ali AA. Outcomes from an interprofessional, dementia-focused, telementoring program: a brief report. Gerontol Geriatr Educ 2023:1-6. [PMID: 37647226 PMCID: PMC10902176 DOI: 10.1080/02701960.2023.2253175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Despite a burgeoning older-adult population, the number of health-care professionals with geriatric expertise continues to lag behind. In 2014, the American Geriatrics Society's position statement encouraged interprofessional training for health-care professionals. Telementoring remotely connects clinicians with specialists for education and group mentoring. This dementia-focused, 11-month, 1-hour each, telementoring program was modeled on the Alzheimer's Association ECHO. Our interprofessional expert panel consisted of a geriatrician, a geriatric psychiatrist, an adult nurse practitioner (with geriatric expertise), two geriatric pharmacists, a licensed social worker (coordinating a dementia day program), and a project coordinator. Learners were residents in family medicine and general psychiatry, physician assistant residents in mental health and geriatric psychiatry fellows (total = 31). There was a significant improvement in learner intentions to change medication prescribing by midpoint assessment (p = 0.04). Learners reported few barriers to incorporating skills they learned. An interprofessional telementoring program can help nongeriatric practitioners improve skills in caring for older adults.
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Affiliation(s)
- Julianna Fernandez
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Kathryn S Agarwal
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amber B Amspoker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Kyler M Godwin
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Sabrina Pickens
- College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Jasmin Lindo
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Ali Abbas Asghar-Ali
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
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Woodard L, Amspoker AB, Hundt NE, Gordon HS, Hertz B, Odom E, Utech A, Razjouyan J, Rajan SS, Kamdar N, Lindo J, Kiefer L, Mehta P, Naik AD. Comparison of Collaborative Goal Setting With Enhanced Education for Managing Diabetes-Associated Distress and Hemoglobin A1c Levels: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e229975. [PMID: 35507345 PMCID: PMC9069258 DOI: 10.1001/jamanetworkopen.2022.9975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Type 2 diabetes is a prevalent and morbid condition. Poor engagement with self-management can contribute to diabetes-associated distress and hinder diabetes control. OBJECTIVE To evaluate the implementation and effectiveness of Empowering Patients in Chronic Care (EPICC), an evidence-based intervention to improve diabetes-associated distress and hemoglobin A1c (HbA1c) levels after the intervention and after 6-month maintenance. DESIGN, SETTING, AND PARTICIPANTS This hybrid (implementation-effectiveness) randomized clinical trial was performed in Veterans Affairs clinics across Illinois, Indiana, and Texas from July 1, 2015, to June 30, 2017. Participants included adults with uncontrolled type 2 diabetes (HbA1c level >8.0%) who received primary care during the prior year in participating clinics. Data collection was completed on November 30, 2018, and data analysis was completed on June 30, 2020. All analyses were based on intention to treat. INTERVENTIONS Participants in EPICC attended 6 group sessions based on a collaborative goal-setting theory led by health care professionals. Clinicians conducted individual motivational interviewing sessions after each group. Usual care was enhanced (EUC) with diabetes education. MAIN OUTCOMES AND MEASURES The primary outcome consisted of changes in HbA1c levels after the intervention and during maintenance. Secondary outcomes included the Diabetes Distress Scale (DDS), Morisky Medication Adherence Scale, and Lorig Self-efficacy Scale. Secondary implementation outcomes included reach, adoption, and implementation (number of sessions attended per patient). RESULTS A total of 280 participants with type 2 diabetes (mean [SD] age, 67.2 [8.4] years; 264 men [94.3]; 134 non-Hispanic White individuals [47.9%]) were equally randomized to EPICC or EUC. Participants receiving EPICC had significant postintervention improvements in HbA1c levels (F1, 252 = 9.12, Cohen d = 0.36 [95% CI, 0.12-0.59]; P = .003) and DDS (F1, 245 = 9.06, Cohen d = 0.37 [95% CI, 0.13-0.60]; P = .003) compared with EUC. During maintenance, differences between the EUC and EPICC groups remained significant for DDS score (F1, 245 = 8.94, Cohen d = 0.36 [95% CI, 0.12-0.59]; P = .003) but not for HbA1c levels (F1, 252 = 0.29, Cohen d = 0.06 [95% CI, -0.17 to 0.30]; P = .60). Improvements in DDS scores were modest. There were no differences between EPICC and EUC in improvements after intervention or maintenance for either adherence or self-efficacy. Among all 4002 eligible patients, 280 (7.0%) enrolled in the study (reach). Each clinic conducted all planned EPICC sessions and cohorts (100% adoption). The EPICC group participants attended a mean (SD) of 4.34 (1.98) sessions, with 54 (38.6%) receiving all 6 sessions. CONCLUSIONS AND RELEVANCE A patient-empowerment approach using longitudinal collaborative goal setting and motivational interviewing is feasible in primary care. Improvements in HbA1c levels after the intervention were not sustained after maintenance. Modest improvements in diabetes-associated distress after the intervention were sustained after maintenance. Innovations to expand reach (eg, telemedicine-enabled shared appointments) and sustainability are needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01876485.
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Affiliation(s)
- LeChauncy Woodard
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Humana Integrated Health System Sciences Institute, University of Houston, Houston, Texas
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, Texas
| | - Amber B. Amspoker
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Natalie E. Hundt
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center, VA Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
- Section of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago
- Institute for Health Research and Policy, University of Illinois Chicago
| | - Brian Hertz
- Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
- Division of Internal Medicine, Hines Veterans Affairs Hospital, Hines, Illinois
- Office of Veterans Access to Care, US Department of Veterans Affairs, Washington, DC
| | - Edward Odom
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Anne Utech
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Nutrition and Food Services, US Department of Veterans Affairs, Washington, DC
| | - Javad Razjouyan
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC
| | - Suja S. Rajan
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center, Houston
| | - Nipa Kamdar
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jasmin Lindo
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lea Kiefer
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Praveen Mehta
- Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
- Veterans Integrated Network 16 (Great Lakes VA Health System), Chicago, Illinois
| | - Aanand D. Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. Debakey Veterans Affairs (VA) Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center, Houston
- Consortium on Aging, University of Texas Health Science Center, Houston
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