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Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

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Date
2015-05
Authors
Edelman, David
Dolor, Rowena J
Coffman, Cynthia J
Pereira, Katherine C
Granger, Bradi B
Lindquist, Jennifer H
Neary, Alice M
Harris, Amy J
Bosworth, Hayden B
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(9 total)
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Abstract
BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.
Type
Journal article
Subject
Aged
Behavior Therapy
Community Health Services
Confidence Intervals
Diabetes Mellitus, Type 2
Female
Follow-Up Studies
Health Behavior
Humans
Hypertension
Male
Middle Aged
Nurse's Role
Odds Ratio
Patient Compliance
Risk Assessment
Severity of Illness Index
Single-Blind Method
Statistics, Nonparametric
Treatment Outcome
Permalink
https://hdl.handle.net/10161/10210
Published Version (Please cite this version)
10.1007/s11606-014-3154-9
Publication Info
Edelman, David; Dolor, Rowena J; Coffman, Cynthia J; Pereira, Katherine C; Granger, Bradi B; Lindquist, Jennifer H; ... Bosworth, Hayden B (2015). Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial. J Gen Intern Med, 30(5). pp. 626-633. 10.1007/s11606-014-3154-9. Retrieved from https://hdl.handle.net/10161/10210.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Cha
Coffman

Cynthia Jan Coffman

Associate Professor of Biostatistics & Bioinformatics
Dolor

Rowena Joy Dolor

Professor of Medicine
Rowena J. Dolor, MD, MHS did her medical training and internal medicine residency at Duke University Medical Center. She completed the Ambulatory Care/Health Services Research fellowship at the Durham VA Medical Center in 1996 and obtained her Masters in Health Sciences degree in Biometry (renamed MHS in Clinical Research) from the Duke University School of Medicine in 1998. Dr. Dolor was a staff physician in the Ambulatory Care Service at the Durham VA Medical Center and Research Associate at t
Edelman

David Edward Edelman

Professor of Medicine
My general interests are in the improve quality of care for chronic illness, using diabetes as a model. While I have performed research on screening for, diagnosis of, and clinical severity of unrecognized diabetes in patient care settings, my current line of work is in using health systems interventions to prevent cardiovascular disease, and to improve outcomes from comorbid diabetes and hypertension.
Granger

Bradi Bartrug Granger

Research Professor in the School of Nursing
Dr. Bradi Granger is a Research Professor at Duke University School of Nursing, Director of the Duke Heart Center Nursing Research Program, and adjunct faculty at the University of Gothenburg, Sweden. She is also a core faculty at the Duke-Margolis Center for Health Policy. Dr. Granger received her doctorate in nursing from the University of North Carolina at Chapel Hill, her MSN from Duke University, and her BSN from the University of Tennessee at Knoxville. Dr. Granger has extensive
Pereira

Katherine Colligan Pereira

Clinical Professor Emerita in the School of Nursing
diabetes, diabetes prevention, Polycystic Ovary Syndrome, pregnancy and diabetes
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