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

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

United States

2015-06-11T18:59:48Z

2015-05

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.

http://www.ncbi.nlm.nih.gov/pubmed/25567758

1525-1497

https://hdl.handle.net/10161/10210

eng

Springer Science and Business Media LLC

J Gen Intern Med

10.1007/s11606-014-3154-9

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

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

Journal article

Edelman, David|0000-0001-7112-6151

Dolor, Rowena J|0000-0001-7317-9468

Coffman, Cynthia J|0000-0002-4554-1463

Granger, Bradi B|0000-0003-0828-6851

Bosworth, Hayden B|0000-0001-6188-9825

http://www.ncbi.nlm.nih.gov/pubmed/25567758

626

633

5

Basic Science Departments

Biostatistics & Bioinformatics

Center for the Study of Aging and Human Development

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, General Internal Medicine

Psychiatry & Behavioral Sciences

School of Medicine

School of Nursing

Published

30