Diabetes self-management support using mHealth and enhanced informal caregiving.

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2014-02-25
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Abstract
OBJECTIVE To characterize diabetes patient engagement and clinician notifications for an mHealth interactive voice response IVR service DESIGN Observational study METHODS For three to six months VA patients with diabetes received weekly IVR calls assessing health status and self care along with tailored education Patients could enroll with an informal caregiver who received suggestions on self management support Notifications were issued to clinicians when patients reported significant problems RESULTS Patients n 303 participated for a total of 5684 patient weeks during which 84 of calls were completed The odds of call completion decreased over time AOR 0 96 p Under 0 001 and were lower among unmarried patients AOR 0 67 p 0 038 and those who had difficulties with health literacy AOR 0 67 p 0 039 diabetes related distress AOR 0 30 p 0 018 or medication nonadherence AOR 0 57 p 0 002 Twenty one clinician notifications were triggered per 100 patient weeks The odds of notification were higher during the early weeks of the program AOR 0 95 p Under 0 001 and among patients who were older AOR 1 03 p 0 004 or more physically impaired AOR 0 97 p Under 0 001 CONCLUSIONS By providing information that is reliable valid and actionable IVR based mHealth services may increase access to between visit monitoring and diabetes self management support The system detects abnormal glycemia and blood pressure levels that might otherwise go unreported although thresholds for clinician notifications might require adjustment to avoid overloading clinicians Patient engagement might be enhanced by addressing health literacy and psychological distress
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Client, Continuity of care, Quality of care, Access to information or data, Loss to follow up, Diabetes, Chronic care, Treatment adherence, Remote client-to-provider consultations (Telemedicine), Disease management, Data collection and reporting
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