Clinical StudiesDo automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?☆
Section snippets
Patient enrollment
Participants were enrolled from two general medicine clinics of a county health care system. Research assistants reviewed medical records of patients with scheduled appointments to identify adults with a diagnosis of diabetes mellitus or an active prescription for a hypoglycemic agent. We excluded patients who were >75 years of age, had a diagnosed psychotic disorder, disabling sensory impairment, or life expectancy of <12 months, or whose primary language was neither English nor Spanish. For
Results
Of the 588 patients identified as potentially eligible, 46 patients were excluded at the request of their physician, 148 declined participation, and 114 were not enrolled for some other reason (eg, they left the clinic before they could be approached). The remaining 280 patients were enrolled. Compared with patients who were potentially eligible but not enrolled, enrollees were somewhat more likely to be female (51% versus 59%, P = 0.04) and somewhat younger (mean age [± SD] 57 ± 10 years
Discussion
The results of this randomized, controlled trial suggest that automated telephone assessment and self-care education calls with nurse follow-up improved patients’ self-care and glycemic control, and decreased their symptom burden. These improvements were achieved with an average of less than 6 minutes per month of nurse-patient contact. Through automated telephone assessments, the nurse was able to use time more judiciously, focusing on the patients who most needed assistance. The automated
Acknowledgements
We thank Eunice Coeter and the clinicians and patients of the Moorpark Clinics, Santa Clara Valley Medical Center; Carol Gangitano, MSN, for her contribution as intervention nurse; and Edgar O. Alvarez, Dara J. Amboy, and Vivian Schiedler for assistance with translation, data collection, and data processing.
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Supported by the Clinical Research Grants Program of the American Diabetes Association and by the Health Services Research and Development Service and Mental Health Strategic Health Group, Department of Veterans Affairs.