Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.
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 articleSubject
AgedBehavior 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
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https://hdl.handle.net/10161/10210Published Version (Please cite this version)
10.1007/s11606-014-3154-9Publication 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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Show full item recordScholars@Duke
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
Cynthia Jan Coffman
Associate Professor of Biostatistics & Bioinformatics
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
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.
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
Katherine Colligan Pereira
Clinical Professor Emerita in the School of Nursing
diabetes, diabetes prevention, Polycystic Ovary Syndrome, pregnancy and diabetes
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