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Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention.

Authors:

Lewinski, Allison A; Patel, Uptal D; Diamantidis, Clarissa J; Oakes, Megan; Baloch, Khaula; Crowley, Matthew J; Wilson, Jonathan; Pendergast, Jane; Biola, Holly; Boulware, L Ebony; Bosworth, Hayden B

Affiliation:

Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
Gilead Sciences, Inc, Foster City, CA, United States
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
Outcomes Research Group, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
Department of Family Medicine, Lincoln Community Health Center, Durham, NC, United States
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
School of Nursing, Duke University, Durham, NC, United States

Source:

Journal of Medical Internet Research (J MED INTERNET RES), Apr2019; 21(4): N.PAG-N.PAG. (1p)

Publication Type:

journal article - research

Language:

English

Major Subjects:

Diabetes Mellitus, Type 2 -- Therapy
Telemedicine -- Methods
Hypertension -- Therapy

Minor Subjects:

Human; Middle Age; Female; Pilot Studies; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Impact of Events Scale

Abstract:

Background: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support.Objective: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States.Methods: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention.Results: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls.Conclusion: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact.Trial Registration: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU).

Journal Subset:

Biomedical; Canada; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed

Instrumentation:

Impact of Events Scale (IES)

ISSN:

1438-8871

MEDLINE Info:

PMID: NLM30964439 NLM UID: 100959882

Grant Information:

IK2 HX001514/HX/HSRD VA/United States; IK6 HX003161/HX/HSRD VA/United States; K23 DK099385/DK/NIDDK NIH HHS/United States; P30 DK096493/DK/NIDDK NIH HHS/United States; R34 DK102166/DK/NIDDK NIH HHS/United States; UL1 TR002553/TR/NCATS NIH HHS/United States

Entry Date:

20200216

Revision Date:

20220127

DOI:

10.2196/12541 

Accession Number:

136207570

Database:

CINAHL Plus with Full Text