Background Many health care systems face barriers to implementing resource-intensive care management programs for patients with poorly controlled diabetes. Mobilizing patients to provide reciprocal peer support may enhance care management and improve clinical outcomes. Objective To compare the effectiveness of a reciprocal diabetes peer support program (RPS) with nurse care management (NCM) in improving glycemic control in real-world clinical settings. Design Six-month parallel randomized controlled effectiveness study from 2007–2010 (Trial Registration NCT00320112) Setting Two U.S. Veterans’Affairs (VA) health care facilities Participants 244 male diabetes patients with a hemoglobin A1c (HbA1c) in the prior 6 months of 7.5% or more. Primary Funding Source VA Health Services Research and Development (HSR&D) Measurements The primary outcome was change in HbA1c between baseline and six months. Secondary outcomes were new insulin starts and intensification, blood pressure, diabetes-specific social support, emotional distress, and medication adherence. Intervention Participants in both arms attended an initial session led by a nurse care manager to review and discuss their point-of-service HbA1c and blood pressure values, and most recent medical record cholesterol values. RPS patients then participated in a group session to set diabetes-related behavioral goals, receive brief training in peer communication skills, and be paired with another age-matched participant. Paired peer partners were encouraged to talk weekly using a telephone platform that recorded call frequency and duration and provided automated reminders promoting peer contact. Intervention participants were also offered three optional 1.5 hour patient-driven group sessions at months 1, 3, and 6 to share concerns, questions, strategies, and progress on goals. Patients in the NCM arm attended a 1.5 hour session to receive education on care manager services and diabetes educational materials and be assigned to a nurse care manager with whom they were encouraged to follow up regularly. Results Of the 244 patients enrolled, at six months 216 (89%) completed the HbA1c and 231 (95%) the survey assessments. RPS participants had a mean HbA1c of 8.02% at baseline, which improved to 7.73% at six months (−0.29%) compared with an average increase in HbA1c among NCM participants (7.93 to 8.22 [SD 0.29]). The difference between groups was 0.58% (p=0.004). Among patients with a baseline HbA1c >8.0%, RPS participants had a mean decrease of 0.88% compared with a 0.07% decrease among NCM participants (p<0.001). Eight RPS patients started insulin compared to one NCM patient (p=0.02), and RPS participants reported greater increases in diabetes social support than NCM participants (+11.4 vs. +4.5, p=0.01). There were no differences between groups at follow-up in blood pressure, self-reported medication adherence, or diabetes-specific distress. Limitations The study was limited to male veterans. It will be important to replicate this study in gender-mixed s...

To estimate the societal economic burden and the governmental budgetary impact of the following visual disorders among US adults aged 40 years and older: visual impairment, blindness, refractive error, agerelated macular degeneration, cataracts, diabetic retinopathy, and primary open-angle glaucoma. Design: We estimated 3 components of economic burden: direct medical costs, other direct costs, and productivity losses. We used private insurance and Medicare claims data to estimate direct medical costs; epidemiologic evidence from multiple published sources to estimate other direct costs, such as nursing home costs; and data from the Survey of Income and Program Participation to estimate productivity losses. We used budgetary documents and our direct medical and other direct cost estimates to approximate the governmental budgetary impact.

On average, the increases in medical spending since 1960 have provided reasonable value. However, the spending increases in medical care for the elderly since 1980 are associated with a high cost per year of life gained. The national focus on the rise in medical spending should be balanced by attention to the health benefits of this increased spending.

Katie Couric's televised colon cancer awareness campaign was temporally associated with an increase in colonoscopy use in 2 different data sets. These findings suggest that a celebrity spokesperson can have a substantial impact on public participation in preventive care programs.

BACKGROUND:For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians.

OBJECTIVE -Knowledge of one's actual and target health outcomes (such as HbA 1c values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one's most recent HbA 1c test result and 2) whether knowing one's HbA 1c value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control. RESULTS -Of the respondents, 66% reported that they did not know their last HbA 1c value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA 1c knowledge. Respondents who knew their last HbA 1c value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05-2.42) and better reported understanding of their diabetes care (P Ͻ 0.001). HbA 1c knowledge was not associated with respondents' diabetes care self-efficacy or reported self-management behaviors. RESEARCH DESIGN AND METHODS CONCLUSIONS -Respondents who knew theirHbA 1c values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one's HbA 1c level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients' diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes. Diabetes Care 28:816 -822, 2005A growing body of evidence suggests that patients with chronic diseases who are engaged and active participants in their health care have better health outcomes (1-4). For example, patients who have completed chronic disease self-management training programs have improved self-efficacy and physical functioning and less acute care use than nonparticipants (2,5-8). Chronic illness care self-efficacy is positively associated with health outcomes (9 -15). Similarly, collaborating with health care providers and engaging in shared clinical decision making are associated with better selfcare behaviors and disease outcomes (1,6,14,16 -20).Less is known, however, about the specific skills, knowledge, beliefs, and motivations that patients need to most effectively participate in their chronic disease management. Patient knowledge of actual and target disease management outcomes (e.g., HbA 1c test results) is hypothesized to be an important prerequisite for effective patient "activation." Providing immediate feedback of HbA 1c values to insulin-taking diabetic adults and their providers (21) and graphical information to patients on their HbA 1c and other laboratory values has been found to improve glycemic control and other diabetes outcomes (22). Organizations such as the American Diabetes A...

Annual retinal screening for all patients with type 2 diabetes without previously detected retinopathy may not be warranted on the basis of cost-effectiveness, and tailoring recommendations to individual circumstances may be preferable. Organizations evaluating quality of care should consider costs and benefits carefully before setting universal standards.

Annual and periodic screening for depression cost more than $50 000/QALY, but one-time screening is cost-effective. The cost-effectiveness of screening is likely to improve if treatment becomes more effective.