Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

Naik, Aanand D.; Palmer, Nynikka R.; Petersen, Nancy J.; Street, Richard L.; Rao, Radha; Suarez‐Almazor, María E.; Haidet, Paul

doi:10.1001/archinternmed.2011.70

Cited by 156 publications

(211 citation statements)

References 31 publications

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“…Later, all of these aspects of chronic care were included in the chronic care model [24][25][26]. On top of this, we added individualised goal setting [27,28]. In complex interventions the effect cannot easily be ascribed to single elements, but it is likely that the improvements in both risk factors and endpoints can be explained, at least partly, by the combined effect of small changes in process and lifestyle measures, which we were unable to pick up with our relatively simple data collection instruments ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

et al. 2013

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Aims/hypothesis This study is a 19 year observational follow-up of a pragmatic open multicentre clusterrandomised controlled trial of 6 years of structured personal diabetes care starting from diagnosis. Methods A total of 1,381 patients aged ≥40 years and newly diagnosed with type 2 diabetes were followed up in national registries for 19 years. Clinical follow-up was at 6 and 14 years after diabetes diagnosis. The original 6 year intervention included regular follow-up and individualised goal setting, supported by prompting of doctors, clinical guidelines, feedback and continuing medical education (ClinicalTrials.gov NCT01074762). The registry-based endpoints were: incidence of any diabetes-related endpoint; diabetes-related death; all-cause mortality; myocardial infarction (MI); stroke; peripheral vascular disease; and microvascular disease.Results At 14 year clinical follow-up, group differences in risk factors from the 6 year follow-up had levelled out, although the prevalence of (micro)albuminuria and level of triacylglycerols were lower in the intervention group. During 19 years of registry-based monitoring, all-cause mortality was not different between the intervention and comparison groups (58.9 vs 62.3 events per 1,000 patientyears, respectively; for structured personal care, HR 0.94, 95% CI 0.83, 1.08, p=0.40), but a lower risk emerged for fatal and non-fatal MI (27.3 vs 33.5, HR 0.81, 95% CI 0.68, 0.98, p=0.030) and any diabetes-related endpoint (69.5 vs 82.1, HR 0.83, 95% CI 0.72, 0.97, p=0.016). These differences persisted after extensive multivariable adjustment. Conclusions/interpretation In concert with features such as prompting, feedback, clinical guidelines and continuing medical education, individualisation of goal setting and drug treatment may safely be applied to treat patients newly diagnosed with type 2 diabetes to lower the risk of diabetes complications.

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Section: Discussionmentioning

confidence: 99%

Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

et al. 2013

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“…Prospective studies in hypertension and diabetes mellitus have shown that communication about treatment goals within a collaborative treatment setting is associated with improved outcomes (32,33). In the current study, SU goal knowledge was independently associated with an increase in the number of SU measurements during the first 2 years following ULT initiation.…”

Section: Discussionmentioning

confidence: 45%

“…While data supporting the need for specific knowledge are limited, goal setting and goal pursuit are hypothesized to be integral aspects of persuading and motivating patients to adopt positive health behaviors (1). For example, collaborative goal-setting has been associated with improved outcomes in other chronic health conditions, including diabetes mellitus and hypertension, where treat-to-target approaches have garnered greater support (32,33). The Chronic Care Model suggests that optimal outcomes may be achieved by knowledgeable patients actively engaged in collaborative care with a prepared, proactive medical team (34,35).…”

Section: Discussionmentioning

confidence: 99%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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Objective. To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT).Methods. This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included goutspecific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. Results. The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. Conclusion. There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

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“…In a study of patients in diabetes self-management support groups, patients were randomly assigned to traditional patient education or to goal setting with concrete behaviorchange agreements called action plans. 13 The group doing action plans had a significant reduction in HbA 1c compared with the patient education group, whose HbA 1c levels did not change.Medication adherence counseling. Effective strategies for optimizing medication adherence are based on coaching techniques that include eliciting the patient's feelings about taking the medication (ask-tell-ask), ensuring that the patient understands the instructions (closing the loop), and customizing the regimen in accordance with the patient's wishes (ask-tell-ask and behavior-change action plans).…”

mentioning

confidence: 85%

Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching?

Goldman

Ghorob

Hessler

et al. 2015

The Annals of Family Medicine

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PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA 1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling.METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTSOf the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches' perceptions of the training. CONCLUSIONSOf low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught. INTRODUCTIONH ealth coaching is the process of engaging patients with chronic conditions in their care by increasing their knowledge, skills, and confidence to the point that they become informed, active participants in the management of their conditions. 1 Patients trained as peer health coaches can provide health coaching to other patients. A recent randomized controlled trial found that patients with poorly controlled diabetes had significantly reduced hemoglobin A 1C (HbA 1c ) levels after 6 months of peer coaching compared with patients who did not receive peer coaching.2 This paper reports on the characteristics and training experiences of these peer coaches.The peer coaches were low-income patients with diabetes who had backgrounds similar to those of the patients they coached. The process that transformed these ordinary patients into effective peer coaches was training and mentoring using the Evidence-Based Health Coaching curriculum developed by 2 of the authors (A.G. and T.B.). 3 The core features of evidence-based health coaching are described in the Methods section. This paper addresses the question, did the low-income patients with diabetes recruited to become peer coaches master and utilize the evidence-based health coaching curriculum? S37 METHODSThe peer coaches described in this paper were part of a randomized controlled trial comparing peer coaching to usual care for patients with poorly controlled diabetes, conducted in conjunction w...

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Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

Cited by 156 publications

References 31 publications

Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

Target Serum Urate: Do Gout Patients Know Their Goal?

Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching?

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