Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease.

Abstract

Background

African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.

Objective

The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.

Research design

Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.

Measures

The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.

Results

Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m; 95% confidence interval: -3.3, -0.02).

Conclusion

A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1097/mlr.0000000000001387

Publication Info

Kobe, Elizabeth A, Clarissa J Diamantidis, Hayden B Bosworth, Clemontina A Davenport, Megan Oakes, Anastasia-Stefania Alexopoulos, Jane Pendergast, Uptal D Patel, et al. (2020). Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease. Medical care, 58(11). pp. 968–973. 10.1097/mlr.0000000000001387 Retrieved from https://hdl.handle.net/10161/29645.

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.

Scholars@Duke

Diamantidis

Clarissa Jonas Diamantidis

Adjunct Associate Professor of Medicine
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 Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Davenport

Tina Davenport

Biostatistician, Senior

Clemontina A. Davenport earned a MSTAT and PhD in Statistics at NC State University. Dr. Davenport has extensive collaborative research experience investigating factors that may explain racial disparities in health outcomes, primarily in kidney disease, but also in diabetes, hypertension cardiovascular disease, and other areas. She teaches a first-year masters level class and is passionate about teaching, mentorship, and the importance of diversity and equity in research and healthcare.

Alexopoulos

Anastasia Stefania Alexopoulos

Assistant Professor of Medicine
Pendergast

Jane Frances Pendergast

Professor Emeritus of Biostatistics & Bioinformatics

Dr. Pendergast is a senior faculty member in the Department of Biostatistics & Bioinformatics, with specialized expertise in multivariate and longitudinal data.  Before coming to Duke, she was a Statistics/Biostatistics faculty member at the Universities of Florida and Iowa.  Her primary collaborations at Duke are with members of the Division of General Internal Medicine and the Aging Center.

Patel

Uptal Dinesh Patel

Adjunct Professor in the Department of Medicine

Uptal Patel, MD is an Adjunct Professor interested in population health with a broad range of clinical and research experience. As an adult and pediatric nephrologist with training in health services and epidemiology, his work seeks to improve population health for patients with  kidney diseases through improvements in prevention, diagnosis and treatment.

Prior efforts focused on four inter-related areas that are essential to improving kidney health: i) reducing the progression of chronic kidney disease by improving its detection and management, particularly by leveraging technology to facilitate engagement and self-management; ii) elucidating the inter-relationships between kidney disease and cardiovascular disease, which together amplify the risk of death; iii) improving the evidence in nephrology through comparative effectiveness research, including clinical trials, observational studies, and meta-analyses; and iv) promoting more optimal clinical health policy for all patients with kidney disease. These inter-disciplinary projects have been funded by a variety of public and private sources including the Robert Wood Johnson Foundation, Veterans Affairs, National Institutes of Health, Agency for Healthcare Research & Quality, Food and Drug Administration, Centers for Medicare & Medicaid Services, Renal Physicians Association, and the American Society of Nephrology. 

Current efforts seek to advance novel therapies for kidney diseases through early clinical development that he leads at AstraZeneca.

Crowley

Matthew Janik Crowley

Associate Professor of Medicine

Diabetes, Hypertension, Health Services Research


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