Objective To determine if the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high risk type 2 diabetes patients. Methods A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n=313) or those who received the intervention (n= 232) with additional practice embedded NCM care, including MI-guided behavior change counseling. NCMs received intensive MI training with ongoing fidelity assessment. Results Systolic BP was better in the intervention group (131±15.9 vs. 135±18.2, p < 0.05). HbA1c, LDL, and diastolic BP improved in both groups: HbA1c (control group 9.1% to 8.0%, intervention group 8.8% to 7.8%), LDL (control group 127 to 100 mg/dL, intervention group 128 to 102 mg/dL), diastolic BP (control group 78 to 74 mm Hg, intervention group 80 to 74 mm Hg). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance. Conclusions NCMs and MI improved systolic BP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia might also be needed. Significant findings of the study In patients with type 2 diabetes, an intervention with nurse case management and motivational interviewing improves systolic blood pressure, depression, and screening for complications. What this study adds First study to look at the benefit of the addition of motivational interviewing to nurse case management in the care of the high-risk adult with type 2 diabetes. Particular attention was given to ensuring fidelity to the motivational interviewing approach.
Aim To determine how patients with Type 2 DM feel about a Motivational Interviewing (MI) intervention designed to promote positive behavior change. Method Qualitative study using focus groups conducted by the same facilitator. Setting Family or general internal medicine practice clinics affiliated with an academic medical center and a community general hospital. One site consisted of primarily low income Hispanic patients. Participants Four focus groups consisting of nineteen adult patients with Type 2 Diabetes Mellitus solicited from a large NIH-funded randomized controlled trial on MI and Diabetes. Results Across and within group analysis was performed on transcripts of the taped interviews. Patient perceptions of standard care were largely negative, with several individuals describing paternalistic and demeaning attitudes. Five themes related to MI emerged: Nonjudgmental Accountability, Being Heard and Responded to as a Person, Encouragement and Empowerment, Collaborative Action Planning & Goal Setting, and Coaching Rather than Critiquing. Conclusions Some patients with Type 2 Diabetes are receptive to motivational interviewing which is a provider approach that is more patient-centered and empowering than traditional care.
IntroductionThe primary objective of this work was to develop a diabetes education book, to pilot its use, and to evaluate its impact on patient care. The secondary objective was to compare the value of providing only the book to patients versus providing the book along with a brief tutorial given by a nurse on how to use the book.MethodsA diabetes education book was developed through a social marketing approach. The impact of the book was then tested in a pilot, prospective, randomized controlled trial evaluating diabetes knowledge, emotional distress, self-care behavior, and clinical outcomes in a primary care patient population. The three-arm study randomized one group to usual care (n=33), one group to receive the book alone (n=33), and one group to receive the book with a brief nurse tutorial (n=34). Patients completed surveys at baseline, 4 weeks, 3 months, and 6 months to assess knowledge (Knowledge Questionnaire), self-care behaviors (Summary of Diabetes Self Care Activities [SDSCA] survey), and disease-related distress (Problem Areas in Diabetes [PAID] scale).ResultsA patient advocacy committee identified a need for information on basic diabetes knowledge, diet, medications, complications, preparing for a visit, and plans for daily life. Using social marketing with a focus on low literacy, the Penn State Hershey Diabetes Playbook was created. The pilot study showed a trend towards improved knowledge, decreased distress, and improved self-care behaviors in patients who received the book. There was no difference in outcomes in patients who were provided the book alone versus those who received a brief nurse tutorial along with the book.ConclusionSocial marketing techniques and low literacy awareness are useful in developing diabetes educational materials.
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