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Costs and effects of a telephonic diabetes self-management support intervention using health educators.

ABSTRACT: Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness.Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported.The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators.Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.

SUBMITTER: Schechter CB

PROVIDER: S-EPMC4761277 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Costs and effects of a telephonic diabetes self-management support intervention using health educators.

Schechter Clyde B CB Walker Elizabeth A EA Ortega Felix M FM Chamany Shadi S Silver Lynn D LD

Journal of diabetes and its complications 20151124 2

<h4>Background</h4>Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectivenes ...[more]

PMID: 26750743

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Project description:Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps).This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and functional status with secondary outcomes of 6-month changes in self-management behaviors/efficacy and patient-centered processes of care. We will also evaluate 6-month changes in cardiometabolic (HbA1c, blood pressure, and LDL) and utilization indicators for all participants.Outcomes will provide evidence regarding real-world implementation of ATSM within a Medicaid managed care plan serving safety net settings. The evaluation trial will provide insight into translating and scaling up health information technology interventions for linguistically and culturally diverse vulnerable populations with chronic disease.ClinicalTrials.gov: NCT00683020.

Project description:Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes.We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults.This was a community-based, randomized controlled, pilot study.One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study.Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church.The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices.Participants' mean age was 54?±?12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months.A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to participants to impact clinical outcomes.

Project description:ObjectiveEffective diabetes self-management can prevent long-term health complications but is often complex and difficult to achieve. Health care professionals' support for patients' autonomy (autonomy support) in managing their diabetes contributes to better diabetes self-care and glycemic control. Most adults with diabetes also receive self-management support from informal health supporters. Yet, the role of autonomy support from these informal health supporters has not been explored. We examined patients' perceived autonomy support from their main health supporter (family member or friend) in relation to their diabetes distress, self-efficacy, self-monitoring of blood glucose (SMBG), medication adherence, and hemoglobin A1c (HbA1c).MethodThree hundred twenty-six veterans with Type 2 diabetes at high risk for complications, who identified a main health supporter, were surveyed using self-report measures of social support, diabetes distress, self-efficacy, and self-care. HbA1c and prescription fill data were extracted from VA electronic records for the 12-months before and after the survey. Linear regression and linear mixed models examined the associations of autonomy support with diabetes distress, self-efficacy, SMBG, medication adherence, and glycemic control, controlling for participant-supporter relationship characteristics and patient-factors.ResultsIn adjusted models, greater autonomy support was associated with lower diabetes distress (B = -.323, SE = .098, p = .001), greater self-efficacy (B = .819, SE = .148, p < .001), more frequent SMBG (B = .297, SE = .082, p < .001), and better subsequent 12-month glycemic control (B = .257, SE = .085, p = .003) but not with medication adherence (B = .001, SE = .020, p = .994).ConclusionsAutonomy support from main health supporters is significantly associated better diabetes related attitudes, self-care, and glycemic control after adjusting for relationship and patient characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Costs and effects of a telephonic diabetes self-management support intervention using health educators.

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Costs and effects of a telephonic diabetes self-management support intervention using health educators.

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