Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings

Brownson, Carol A.; Hoerger, Thomas J.; Fisher, Edwin B.; Kilpatrick, Kerry E.

doi:10.1177/0145721709340931

Cited by 77 publications

(86 citation statements)

References 42 publications

(39 reference statements)

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“…6 Emerging economic analyses of peer support also show diverse benefits. [7][8][9][10][11][12][13] Accordingly, community health workers receive strong emphasis in the World Health Organization's Global Health Workforce Alliance 5 and are prominently mentioned in various provisions of the US Patient Protection and Affordable Care Act. 14 The American Academy of Family Physicians Foundation, with support from the Eli Lilly and Company Foundation, initiated Peers for Progress (http://peersforprogress.org) in 2006 with goals of promoting peer support for those with diabetes and other health challenges around the world.…”

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confidence: 99%

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

Fisher

Ayala

Ibarra

et al. 2015

The Annals of Family Medicine

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SUBSTANTIAL evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.

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confidence: 99%

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

Fisher

Ayala

Ibarra

et al. 2015

The Annals of Family Medicine

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“…Eight studies [156][157][158][159][160][161][162][163] that detailed cost-effectiveness analysis of self-management interventions in people with diabetes met the inclusion criteria. The selected studies were lifestyle modification programmes and telephone interventions (both automated and non-automated).…”

Section: Inclusion Criteriamentioning

confidence: 99%

Managing with Learning Disability and Diabetes: OK-Diabetes – a case-finding study and feasibility randomised controlled trial

House

Bryant

Russell

et al. 2018

Health Technol Assess

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BackgroundObesity and type 2 diabetes are common in adults with a learning disability. It is not known if the principles of self-management can be applied in this population.ObjectivesTo develop and evaluate a case-finding method and undertake an observational study of adults with a learning disability and type 2 diabetes, to develop a standardised supported self-management (SSM) intervention and measure of adherence and to undertake a feasibility randomised controlled trial (RCT) of SSM versus treatment as usual (TAU).DesignObservational study and an individually randomised feasibility RCT.SettingThree cities in West Yorkshire, UK.ParticipantsIn the observational study: adults aged > 18 years with a mild or moderate learning disability, who have type 2 diabetes that is not being treated with insulin and who are living in the community. Participants had mental capacity to consent to research and to the intervention. In the RCT participants had glycated haemoglobin (HbA1c) levels of > 6.5% (48 mmol/mol), a body mass index (BMI) of > 25 kg/m2or self-reported physical activity below national guideline levels.InterventionsStandardised SSM. TAU supported by an easy-read booklet.Main outcome measures(1) The number of eligible participants identified and sources of referral; (2) current living and support arrangements; (3) current health state, including level of HbA1c, BMI and waist circumference, blood pressure and lipids; (4) mood, preferences for change; (5) recruitment and retention in RCT; (6) implementation and adherence to the intervention; (7) completeness of data collection and values for candidate primary outcomes; and (8) qualitative data on participant experience of the research process and intervention.ResultsIn the observational study we identified 147 eligible consenting participants. The mean age was 54.4 years. In total, 130 out of 147 (88%) named a key supporter, with 113 supporters (77%) being involved in diabetes management. The mean HbA1clevel was 54.5 mmol/mol [standard deviation (SD) 14.8 mmol/mol; 7.1%, SD 1.4%]. The BMI of 65% of participants was > 30 kg/m2and of 21% was > 40 kg/m2. Many participants reported low mood, dissatisfaction with lifestyle and diabetes management and an interest in change. Non-response rates were high (45/147, 31%) for medical data requested from the primary care team. In the RCT, 82 participants were randomised. The mean baseline HbA1clevel was 56 mmol/mol (SD 16.5 mmol/mol; 7.3%, SD 1.5%) and the mean BMI was 34 kg/m2(SD 7.6 kg/m2). All SSM sessions were completed by 35 out of 41 participants. The adherence measure was obtained in 37 out of 41 participants. The follow-up HbA1clevel and BMI was obtained for 75 out of 82 (91%) and 77 out of 82 (94%) participants, respectively. Most participants reported a positive experience of the intervention. A low response rate and difficulty understanding the EuroQol-5 Dimensions were challenges in obtaining data for an economic analysis.LimitationsWe recruited from only 60% of eligible general practices, and 90% of participants were on a general practice learning disability register, which meant that we did not recruit many participants from the wider population with milder learning disability.ConclusionsA definitive RCT is feasible and would need to recruit 194 participants per arm. The main barrier is the resource-intensive nature of recruitment. Future research is needed into the effectiveness of obesity treatments in this population, particularly estimating the longer-term outcomes that are important for health benefit. Research is also needed into improving ways of assessing quality of life in adults with a learning disability.Trial registrationCurrent Controlled Trials ISRCTN41897033.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 26. See the NIHR Journals Library website for further project information.

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“…[1][2][3][4] Yet, demonstrating that these programs can yield a positive business case in the short term remains an elusive goal from the perspective of an organization sponsoring the intervention. 5 This is especially true when the intervention in future years must be supported entirely by internal resources and cannot rely on significant external funding from foundations or governmental agencies.…”

Section: Introductionmentioning

confidence: 99%

The Business Case for a Diabetes Self-Management Intervention in a Community General Hospital

Micklethwaite

Brownson

O’Toole

et al. 2012

Population Health Management

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"The business case for a diabetes selfmanagement intervention in a community general hospital." Population Health Management. 15,4. 230-235. (2012 There is a growing and increasingly compelling body of evidence that self-management interventions for persons with type 2 diabetes can be both effective and cost-effective from a societal perspective. Yet, the evidence is elusive that these interventions can produce a positive business case for a sponsoring provider organization in the short term. The lack of a business case limits the enthusiasm for provider organizations to implement these proven quality-enhancing interventions more widely. This article provides a case example of a self-management intervention in a community general hospital targeting an underserved population who have significant barriers to receiving regular health care. The 3-component program sought to improve meaningful access to care, increase health literacy related to type 2 diabetes, and partner with the enrollees to make long-term lifestyle changes. The intervention not only resulted in significant improvements in HbA1c levels (-0.77%) but saved the hospital an average of $551 per active patient per year, primarily by reducing hospital visits. With only 255 actively enrolled patients, the hospital can recover fully its total direct annual personnel and operating costs for the program. Because the program serves patients who would have been seen at other hospitals, it also enhanced care quality and reduced costs for the broader community in which the program is embedded. (Population Health Management 2012;15:230-235)

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Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings

Cited by 77 publications

References 42 publications

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

Managing with Learning Disability and Diabetes: OK-Diabetes – a case-finding study and feasibility randomised controlled trial

The Business Case for a Diabetes Self-Management Intervention in a Community General Hospital

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