Thursday, November 20, 2014

Using phone and fax to improve diabetes care

The Journal of Diabetes and Its Complications just published a study on "Diabetes self-management support using mHealth and enhanced informal caregiving" by a team of VA researchers from Michigan and Stanford. The team set up an IVR phone system for veterans with diabetes. The vets received phone calls every week to assess their status and generate automatic tailored messages about how to deal with their disease. The system was designed to also engage family members and other informal caregivers as well as the clinician. This was a fairly sophisticated system with multiple tree-structured algorithms that took 5 to 10 minutes per call to complete and covered a wide range of issues including hypoglycemia, hyperglycemia, medication adherence, foot self-care, self-monitoring of blood sugar and blood pressure, and so forth. Clinicians received a fax if the system detected a concern.

The paper reports very positive short-term outcomes.  72% of patients agreed to try it and 84% of the scheduled calls were completed. On average, the system detected about one problem for every 5 weeks of patient participation. Patients who had informal caregivers tended to have fewer problems. Of course, the Pareto Principle applies here as everywhere and almost half of the problems were concentrated in 15% of patients. The best news is that the number of problems seemed to decrease over time, suggesting that the patients were achieving better stability.

At this time, there are no data on whether the patients actually got better in terms of physiologic control, complications, utilization or satisfaction with care. However, it looks like the relatively old fashioned technologies of phone and fax still have great potential to enhance care by engaging patients, caregivers and clinicians.

Aikens JE, Zivin K, Trivedi R, Piette JD. Diabetes self-management support using mHealth and enhanced informal caregiving. J Diabetes Complications. 2014;28: 171-6.

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