Dean Schillinger|Margaret A. Handley|Frances Wang|Hali Hammer
Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes
University of California, San Francisco|San Francisco General Hospital|San Francisco General Hospital|University of California, San Francisco|University of California, San Francisco|San Francisco General Hospital|University of California, San Francisco
despite importance selfmanagement support sms studies compared sms interventions involved diverse populations entailed implementation safety net settings examined effects two sms strategies across outcomes corresponding chronic care modela total 339 outpatients poorly controlled diabetes countyrun clinics enrolled threearm trial participants half spoke limited english uninsured andor less high school education randomly assigned usual care interactive weekly automated telephone selfmanagement support nurse followup atsm monthly group medical visits physician health educator facilitation gmv measured 1year changes structure patient assessment chronic illness care pacic communication processes interpersonal processes care ipc outcomes behavioral functional metaboliccompared usual care group atsm gmv groups showed improvements pacic effect sizes 048 050 respectively p 001 atsm group showed improvements ipc effect sizes 040 vs usual care 025 vs gmv p 005 sms arms showed improvements selfmanagement behavior versus usual care arm p 005 gains greater atsm group gmv group effect size 027 p 002 atsm group fewer bed days per month usual care group 17 days p 005 gmv group 23 days p 001 less interference daily activities usual care group odds ratio 037 p 002 observed differences a1c changepatientcentered sms improves certain aspects diabetes care positively influences selfmanagement behavior atsm seems effective communication vehicle gmv improving behavior quality life