Nurse-Telephone Based Cardiovascular Disease Risk Management System
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Duke University Medical Center
Durham, North Carolina
Diabetes and Cardiovascular Disease Risk Factors
Community-based primary care clinics
African Americans |
PROJECT
Patients received monthly calls from nurses to discuss their disease risk management.
In this study, nurses call patients each month for a year to discuss the patients’ cardiovascular disease risk management. The conversations contain both standard and tailored components. The nurses’ discussions focus on teaching the dangers of poor cardiovascular disease control, presenting risk factors clearly and credibly, and enforcing the saliency of the hazard. At each call, topics for discussion are chosen based on an assessment of the patient’s knowledge and stage of behavior change. Nurses then contact providers at three, six, and nine months to provide patient updates and to facilitate medication management. All nurses receive training in community health, cultural sensitivity and motivational interviewing. The intervention takes place in community based primary care clinics affiliated with an academic medical center.
RATIONALE
Patients’ inability to achieve accepted targets of chronic disease control likely arises from a complex interaction of treatment non-adherence and providers’ lack of treatment intensification (clinical inertia). This intervention targets both patients and providers and addresses multiple chronic conditions contributing to cardiovascular disease risk.
A multi-behavior, comprehensive approach is proposed because no one factor has been shown to consistently improve cardiovascular disease outcomes. The intervention is tailored to the needs of vulnerable, high-risk patients and uses existing clinical infrastructure, including nurses. It builds rapport between patients and nurses, which has the potential to improve continuity of care. More frequent contact with patients allows physicians to make decisions about changing medications, ordering additional tests or scheduling additional clinic appointments depending on the patient’s situation.
EVALUATION PLAN
Funded by Finding Answers in 2008.
Researchers are conducting a randomized controlled trial. Patients in the intervention group are receiving monthly telephone-based counseling, while patients in the control group are receiving educational materials about cardiovascular disease reduction at the beginning of the trial and are being offered the option of receiving supplemental educational material by mail during the trial. Clinical outcomes are being measured at baseline and 12 months. Those measures include blood pressure, HbA1c and LDL cholesterol.
Health behaviors and outcomes that are being assessed include aspirin use, medication adherence, diet, exercise, alcohol use, smoking status and weight. Data is also being collected from the telephone call system, including number and duration of calls, and the type of intervention components delivered for each patient. This study is also examining the cost of implementing the intervention on a larger scale and is assessing patient and clinician perceptions of potential barriers, facilitators and challenges to disseminating the intervention. Cost and utilization data are being collected via a patient survey.
Principal Investigators
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Hayden B. Bosworth, PhD (Research Professor, Duke University Medical Center)
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Benjamin Powers, MD (Assistant Professor, Duke University Medical Center)
Publication
The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: Study design and methodology
American Heart Journal. 2009. 158(3): 342-348
Full Article (with subscription)
For More Information
Please contact:
Celine Koropchak, Project Coordinator
Korop001@mc.duke.edu
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