Online tools help diabetics achieve better outcomes
Diabetic patients enrolled in an intervention utilizing online tools to assist with self-management achieved slightly better health outcomes than diabetic patients receiving usual care, according to research published online Nov. 20 by the Journal of the American Medical Informatics Association.
To help diabetic patients better manage their health, the Palo Alto Medical Foundation (PAMF) in Los Altos, Calif., developed a chronic care model that incorporates a multidisciplinary care team led by a nurse manager and a set of online tools, including a personal health record (PHR).
“The chronic care model emphasizes the use of multidisciplinary healthcare teams an an activated patient,” wrote lead author Paul C. Tang, MD, chief innovation and technology officer at the PAMF and associate professor of medicine at Stanford University in Stanford, Calif. “Integrated PHRs can improve patients’ access to their data and facilitate communication with their professional healthcare team. Unlike episodic office visits, remote monitoring technologies and automated alerting and communication capabilities can support greater continuity.”
To test the efficacy of the chronic care model compared to “usual care,” researchers conducted a randomized controlled trial of 415 adult diabetic patients with HbA1C levels of 7.5 percent or higher. Approximately one-half of the participants were assigned to the control group and the other half were assigned to the chronic care model intervention group, which allowed them access to a PHR with health tracking capabilities, wireless glucometers, nurse managers and an online messaging system. Participants in the intervention groups made three in-person visits to a physical setting to learn how to use the online tools, meet with a nurse manager and meet with a dietician.
The intervention group achieved significantly HbA1C levels reductions than the control group at six months, averaging a reduction of 1.32 percent compared with 0.66 percent, but there were no statistically significant differences at 12 months. Patients in the intervention group were also more likely to intensify treatment, express satisfaction with treatment and achieve high cholesterol control. There were no significant differences between the groups in terms of healthcare utilization.
“Diabetes self-management education incorporates the needs, goals and life experiences of people with diabetes and is guided by evidence-based standards,” Tang et al wrote. “Goal setting, using motivational interviewing techniques and being guided by the chronic care model helped patients identify and reach realistic health goals.”