David Edelman|Rowena J Dolor|Cynthia J. Coffman|Katherine Pereira|Bradi B. Granger|Jennifer H. Lindquist|Alice M. Neary|Amy Harris|Hayden B. Bosworth
Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial
Duke Medical Center|Duke Medical Center|Durham VA Medical Center|Duke University Hospital|Duke Medical Center|Duke University Hospital|Duke Medical Center|Durham VA Medical Center|Duke Medical Center|Durham VA Medical Center|Durham VA Medical Center
several trials demonstrated efficacy nurse telephone case management diabetes dm hypertension htn academic vertically integrated systems little known realworld potency interventionsto assess effectiveness nurse behavioral management dm htn community practices among patients diseasesthe study designed patientlevel randomized controlled trialparticipants included adult patients type 2 dm htn receiving care one nine community feeforservice practices subjects required inadequately controlled dm hemoglobin a1c a1c 75 could wellcontrolled htnall patients received call nurse experienced dm htn management every two months period two years total 12 calls intervention patients received tailored dm htn focused behavioral content control patients received nontailored noninteractive information regarding health issues unrelated dm htn eg skin cancer preventionsystolic blood pressure sbp a1c coprimary outcomes measured 6 12 24 months 24 months primary time pointthree hundred seventyseven subjects enrolled 193 randomized intervention 184 control subjects 55 female 50 white mean baseline a1c 91 sd 1 mean sbp 142 mmhg sd 20 eightytwo percent scheduled interviews conducted 69 intervention patients 70 control patients reached 24month time point expressing model estimated differences interventioncontrol 24 months intervention patients similar a1c diff 01 95 ci 03 05 p 051 sbp diff 09 mmhg 95 ci 54 35 p 068 values compared control patients likewise dbp diff 04 mmhg p 076 weight diff 03 kg p 080 physical activity levels diff 153 metminweek p 041 similar control intervention patients results also similar 6 12month time pointsin nine community feeforservice practices telephonic nurse case management lead improvement a1c sbp gains seen telephonic behavioral selfmanagement interventions optimal settings may translate wider range primary care settings