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Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention
BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477575/ https://www.ncbi.nlm.nih.gov/pubmed/30964439 http://dx.doi.org/10.2196/12541 |
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author | Lewinski, Allison A Patel, Uptal D Diamantidis, Clarissa J Oakes, Megan Baloch, Khaula Crowley, Matthew J Wilson, Jonathan Pendergast, Jane Biola, Holly Boulware, L Ebony Bosworth, Hayden B |
author_facet | Lewinski, Allison A Patel, Uptal D Diamantidis, Clarissa J Oakes, Megan Baloch, Khaula Crowley, Matthew J Wilson, Jonathan Pendergast, Jane Biola, Holly Boulware, L Ebony Bosworth, Hayden B |
author_sort | Lewinski, Allison A |
collection | PubMed |
description | BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. OBJECTIVE: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. METHODS: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. RESULTS: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. CONCLUSION: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU) |
format | Online Article Text |
id | pubmed-6477575 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-64775752019-05-08 Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention Lewinski, Allison A Patel, Uptal D Diamantidis, Clarissa J Oakes, Megan Baloch, Khaula Crowley, Matthew J Wilson, Jonathan Pendergast, Jane Biola, Holly Boulware, L Ebony Bosworth, Hayden B J Med Internet Res Original Paper BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. OBJECTIVE: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. METHODS: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. RESULTS: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. CONCLUSION: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU) JMIR Publications 2019-04-09 /pmc/articles/PMC6477575/ /pubmed/30964439 http://dx.doi.org/10.2196/12541 Text en ©Allison A Lewinski, Uptal D Patel, Clarissa J Diamantidis, Megan Oakes, Khaula Baloch, Matthew J Crowley, Jonathan Wilson, Jane Pendergast, Holly Biola, L Ebony Boulware, Hayden B Bosworth. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.04.2019. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Lewinski, Allison A Patel, Uptal D Diamantidis, Clarissa J Oakes, Megan Baloch, Khaula Crowley, Matthew J Wilson, Jonathan Pendergast, Jane Biola, Holly Boulware, L Ebony Bosworth, Hayden B Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title | Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title_full | Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title_fullStr | Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title_full_unstemmed | Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title_short | Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention |
title_sort | addressing diabetes and poorly controlled hypertension: pragmatic mhealth self-management intervention |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477575/ https://www.ncbi.nlm.nih.gov/pubmed/30964439 http://dx.doi.org/10.2196/12541 |
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