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.