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

Publication ,  Journal Article
Edelman, D; Dolor, RJ; Coffman, CJ; Pereira, KC; Granger, BB; Lindquist, JH; Neary, AM; Harris, AJ; Bosworth, HB
Published in: J Gen Intern Med
May 2015

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2015

Volume

30

Issue

5

Start / End Page

626 / 633

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Statistics, Nonparametric
  • Single-Blind Method
  • Severity of Illness Index
  • Risk Assessment
  • Patient Compliance
  • Odds Ratio
  • Nurse's Role
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
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Edelman, D., Dolor, R. J., Coffman, C. J., Pereira, K. C., Granger, B. B., Lindquist, J. H., … Bosworth, H. B. (2015). Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial. J Gen Intern Med, 30(5), 626–633. https://doi.org/10.1007/s11606-014-3154-9
Edelman, David, Rowena J. Dolor, Cynthia J. Coffman, Katherine C. Pereira, Bradi B. Granger, Jennifer H. Lindquist, Alice M. Neary, Amy J. Harris, and Hayden B. Bosworth. “Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.J Gen Intern Med 30, no. 5 (May 2015): 626–33. https://doi.org/10.1007/s11606-014-3154-9.
Edelman D, Dolor RJ, Coffman CJ, Pereira KC, Granger BB, Lindquist JH, et al. Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial. J Gen Intern Med. 2015 May;30(5):626–33.
Edelman, David, et al. “Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.J Gen Intern Med, vol. 30, no. 5, May 2015, pp. 626–33. Pubmed, doi:10.1007/s11606-014-3154-9.
Edelman D, Dolor RJ, Coffman CJ, Pereira KC, Granger BB, Lindquist JH, Neary AM, Harris AJ, Bosworth HB. Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial. J Gen Intern Med. 2015 May;30(5):626–633.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2015

Volume

30

Issue

5

Start / End Page

626 / 633

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Statistics, Nonparametric
  • Single-Blind Method
  • Severity of Illness Index
  • Risk Assessment
  • Patient Compliance
  • Odds Ratio
  • Nurse's Role
  • Middle Aged
  • Male