Impact of Automated Calls With Nurse Follow-Up on Diabetes Treatment Outcomes in a Department of Veterans Affairs Health Care System: A randomized controlled trial
2001
OBJECTIVE — We evaluated automated telephone disease management
(ATDM) with telephone nurse follow-up as a strategy for improving diabetes
treatment processes and outcomes in Department of Veterans Affairs (VA)
clinics. We also compared the results with those of a prior ATDM trial
conducted in a county health care system. RESEARCH DESIGN AND METHODS — A total of 272 VA patients with
diabetes using hypoglycemic medications were randomized. During the 1-year
study period, intervention patients received biweekly ATDM health assessment
and self-care education calls, and a nurse educator followed up with patients
based on their ATDM assessment reports. Telephone surveys were used to measure
patients9 self-care, symptoms, and satisfaction with care. Outpatient service
use was evaluated using electronic databases and self-reports, and glycemic
control was measured by HbA lc and serum glucose testing. RESULTS — At 12 months, intervention patients reported more
frequent glucose self-monitoring and foot inspections than patients receiving
usual care and were more likely to be seen in podiatry and diabetes specialty
clinics. Intervention patients also were more likely than control patients to
have had a cholesterol test. Among patients with baseline HbA lc
levels ≥8%, mean end-point values were lower among intervention patients
than control patients (8.7 vs. 9.2%, respectively; P = 0.04). Among
intervention and control patients with baseline values ≥9%, mean end-point
values were 9.1 and 10.2%, respectively ( P = 0.04). At follow-up,
intervention patients reported fewer symptoms of poor glycemic control than
control patients and greater satisfaction with their health care. CONCLUSIONS — This intervention improved the quality of VA
diabetes care. Intervention effects for most end points replicated findings
from the prior county clinic trial, although intervention—control
differences in the current study were smaller because of the relatively good
self-care and health status among the current study9s enrollees.
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