A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus

Shea, Steven; Weinstock, Ruth S.; Starren, Justin; Teresi, Jeanne A.; Palmas, Walter; Field, Lesley; Morin, Philip C.; Goland, Robin; Izquierdo, Roberto; Wolff, Leor; Ashraf, Mohamed; Hilliman, Charlyn; Silver, Stephanie; Meyer, Suzanne; Holmes, Douglas; Petkova, Eva; Capps, Linnea; Lantigua, Rafael

doi:10.1197/jamia.m1917

Cited by 280 publications

(378 citation statements)

References 57 publications

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“…These findings are consistent with prior studies demonstrating that tailored health education and behavior change programs delivered via information technologies are acceptable to vulnerable groups (12,30,77,78).…”

Section: Resultssupporting

confidence: 82%

“…However, Hispanic participants were significantly less interested than nonHispanics in internet-based self-management support. Since prior work in other settings has shown high acceptance of carefully developed, computer-based health interventions among Hispanics who are trained in their use (30,64,65), this finding may reflect a general discomfort with internet use due to a lack of familiarity. Racial/ ethnic differences in patients' preferences for different communication modalities underscore the need to provide an array of approaches for patients in safety-net settings and to match the strategy with patient preferences.…”

Section: Discussionmentioning

confidence: 82%

“…There has been very little research contrasting self-management support strategies, and health systems need this information in order to decide how to best deliver self-management support (62) There has recently been a focus on internet self-management support applications, often to the exclusion of other strategies (24,30), and this may be particularly problematic for ethnically diverse, underprivileged populations. To our knowledge, this is first study to describe self-management support preferences in a large, racially diverse sample of diabetes patients recruited from multiple public hospital systems.…”

Section: Discussionmentioning

confidence: 99%

“…Common approaches to providing this additional self-management support include telephonebased counseling (7)(8)(9)(10)(11)(12), group medical visits (13)(14)(15)(16)(17)(18)(19)(20)(21), and, increasingly, computer or internetbased programs (22)(23)(24)(25)(26)(27)(28)(29)(30). Efficacy studies of self-management support have shown improvements in patient satisfaction, healthy behaviors, self-efficacy, and, in some cases, utilization and clinical outcomes (31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

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Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

Sarkar

Piette

Gonzales

et al. 2008

Patient Education and Counseling

131

118

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Objectives-We sought to identify interest in different modes of self-management support among diabetes patients cared for in public hospitals, and to assess whether demographic or disease-specific factors were associated with patient preferences. We explored the possible role of a perceived communication need in influencing interest in self-management support.Methods-Telephone survey of a random sample of 796 English and Spanish-speaking diabetes patients (esponse rate 47%) recruited from 4 urban US public hospital systems. In multivariate models, we measured the association of race/ ethnicity, primary language, self-reported health literacy, self-efficacy, and diabetes-related factors on patients' interest in three self-management support strategies (telephone support, group medical visits, and internet -based support). We explored the extent to which patients believed that better communication with providers would improve their diabetes control, and whether this perception altered the relationship between patient factors and selfmanagement support acceptance. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. CI 0.33-0.93). African-Americans were more interested than Whites in all 3 self-management support strategies. Patients with limited self-reported health literacy were more likely to be interested in telephone support than those not reporting literacy deficits. Forty percent reported that their diabetes would be better controlled if they communicated better with their health care provider. This perceived communication benefit was independently associated with interest in self-management support (p<0.001), but its inclusion in models did not alter the strengths of the main associations between patient characteristics and self-management support preferences. NIH Public AccessConclusion-Many diabetes patients in safety-net settings report an interest in receiving selfmanagement support, but preferences for modes of delivery of self-management support vary by race/ethnicity, language proficiency, and self-reported health literacy.Practice Implications-Public health systems should consider offering a range of selfmanagement support services to meet the needs of their diverse patient populations. More broad dissemination and implementation of self-management support may help address the unmet need for better provider communication among diabetes patients in these settings.

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Section: Resultssupporting

confidence: 82%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

Sarkar

Piette

Gonzales

et al. 2008

Patient Education and Counseling

131

118

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“…88,116,143 Management of patients on the basis of telemedicine in co-operation with nurses, where home BP is used as an index, has been reported to have led to a more rapid control of BP in diabetic patients. 144 …”

Section: Diabetes Mellitusmentioning

confidence: 99%

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

et al. 2012

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INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

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Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus

Grant¹,

Wald²,

Schnipper³

et al. 2008

Arch Intern Med

191

263

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Background: Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians. Methods:We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a "Diabetes Care Plan" for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access. Results:We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study par-ticipants were younger (mean age, 56.1 years vs 60.3 years; PϽ.001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; PϽ.001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; PϽ.001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P=.53).Conclusions: Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention's impact on overall risk factor control.

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A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus

Abstract: Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up.

Cited by 280 publications

References 57 publications

Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus

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