Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System

Schillinger, Dean; Hammer, Hali; Wang, Frances; Palácios, Jorge; McLean, Ivonne; Tang, Audrey; Youmans, Sharon L.; Handley, Margaret A.

doi:10.1177/1090198106296772

Cited by 83 publications

(154 citation statements)

References 54 publications

Supporting

Mentioning

152

Contrasting

Order By: Relevance

“…In the survey, rather than measuring acceptance of a particular intervention, we asked patients if they would consider each self-management support strategy in general. Although patients' perceptions of an actual, specific implementation of that strategy may differ substantially, the patterns we detected were similar to acceptance of an actual diabetes intervention in a similar population (73). We did not ask participants to rank the strategies.…”

Section: Discussionmentioning

confidence: 84%

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

Self Cite

131

118

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 84%

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

Self Cite

131

118

View full text Add to dashboard Cite

show abstract

“…For example, we found a per-patient cost of $782 for the combined start-up and ongoing implementation costs of ATSM with nurse care management. If these costs were distributed across the eligible diabetic patients in the clinic system from whom the trial sample was drawn (>2,200 patients) 13 and estimated for ongoing costs only, the annual per-patient cost drops to slightly more than $300 per patient. This amount translates into a roughly 25% decrease in the ongoing costs we estimated for the 112 ATSM patients.…”

Section: Discussionmentioning

confidence: 99%

“…The IDEALL trial (Improving Diabetes Efforts Across Language and Literacy) has been previously described. 12,13,17 In brief, 339 English-, Spanish-, and Cantonese-speaking primary care patients with diabetes in 4 safety net clinics from the San Francisco Department of Public Health's integrated delivery system (Community Health Network) were randomized to receive ATSM, group medical visits, or usual care for 9 months. The interventions were developed as adjuncts to usual care.…”

Section: Trial Overviewmentioning

confidence: 99%

“…Specifi cally, we compared the cost utility of automated telephone self-management support plus nurse care management (ATSM) with that of usual care among diverse patients with diabetes enrolled in a randomized trial. This trial demonstrated 1-year improvements in health behaviors and functional outcomes with ATSM relative to usual care, 12,13 including health-related quality of life measures. The trial did not, however, demonstrate differences in metabolic outcomes (hemoglobin A 1c [HbA 1c ], blood pressure) or use of services (such as emergency services).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Handley¹,

Shumway²,

Schillinger³

2008

The Annals of Family Medicine

View full text Add to dashboard Cite

PURPOSE This study evaluated the cost-effectiveness of an automated telephone self-management support with nurse care management (ATSM) intervention for patients with type 2 diabetes, which was tested among patients receiving primary care in publicly funded (safety net) clinics, focusing on non-English speakers. METHODSWe performed cost analyses in the context of a randomized trial among primary care patients comparing the effects of ATSM (n = 112) and usual care (n = 114) on diabetes-related outcomes in 4 San Francisco safety net clinics. ATSM uses interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in 3 languages for a 9-month period. Cost utility was examined using quality-adjusted life-years (QALYs) derived from changes in scores on the 12-Item Short Form Health Survey. We also examined cost-effectiveness for costs associated with a 10% increase in the proportion of patients meeting diabetes-specifi c public health goals for increasing exercise, as recommended by Healthy People 2010 and the American Diabetes Association. RESULTSThe annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. In sensitivity analyses, costs per QALY ranged from $29,402 to $72,407. The per-patient cost to achieve a 10% increase in the proportion of intervention patients meeting American Diabetes Association exercise guidelines was estimated to be $558 when all costs were considered and $277 when only ongoing costs were considered.CONCLUSIONS The ATSM intervention for diverse patients with diabetes had a cost utility for functional outcomes similar to that of many other accepted interventions targeted at diabetes prevention and treatment, and achieved public health physical activity objectives at modest costs. Because a considerable proportion of costs were fi xed, cost-utility and cost-effectiveness estimates would likely be substantially improved in a scaled-up ATSM program. INTRODUCTIONI n the United States, costs associated with chronic illness care account for nearly 75% of medical expenditures.1 Type 2 diabetes, which affects more than 20 million individuals in this country alone, is associated with substantial morbidity and cost. Although organ damage related to diabetes is well recognized, diabetes also causes functional decline, depression, pain, and lost productivity.2-5 The estimated direct and indirect societal and health system costs attributable to diabetes totaled approximately $132 billion in 2002, with costs expected to rise to $156 billion by 2010. [6][7][8] In recent reviews of the cost-effectiveness of interventions for prevent- COS T-EF F EC T IV ENES S O F AT S M F OR DIA BE T E Sing or treating diabetes in developed countries, the majority of studies focus either on screening for diabetes or on treatment to avert complications, emphasizing medication-sensitive outcomes with long-term benefi ts....

show abstract

“…If appropriately designed and delivered, patients with a variety of sociodemographic characteristics, including patients with limited functional health literacy or English proficiency, will use IBCT as part of their diabetes care (94). Nevertheless, the benefits of these technologies are not equally distributed across patients.…”

Section: Not All Patients Need Ibctmentioning

confidence: 99%

Interactive Behavior Change Technology to Support Diabetes Self-Management

Piette

2007

Diabetes Care

View full text Add to dashboard Cite

Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System

Cited by 83 publications

References 54 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

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Interactive Behavior Change Technology to Support Diabetes Self-Management

Contact Info

Product

Resources

About