Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.
Repository Usage Stats
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.
Community Health Services
Diabetes Mellitus, Type 2
Severity of Illness Index
Published Version (Please cite this version)10.1007/s11606-014-3154-9
Publication InfoEdelman, 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.
More InfoShow full item record
Professor in Population Health Sciences
Dr. Bosworth is a health services research and Associate Director of the Center for Health Services Research in Primary Care at the Durham VA Medical Center. 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 Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides
Associate Professor of Biostatistics and Bioinformatics
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
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.
Professor in the School of Nursing
Dr. Granger is Associate Professor and Associate Director of Duke Translational Nursing Institute. She is also Director of the Duke Heart Center Nursing Research Program and adjunct faculty at the University of Gothenburg, Sweden. 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 clinical experience in cardiovascular nursi
Professor in the School of Nursing
diabetes, diabetes prevention, Polycystic Ovary Syndrome, pregnancy and diabetes
Alphabetical list of authors with Scholars@Duke profiles.