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The Effect of Automated Calls With Telephone Nurse Follow-Up on Patient-Centered Outcomes of Diabetes Care

A Randomized, Controlled Trial

Piette, John D. PhD*; Weinberger, Morris PhD†; McPhee, Stephen J. MD‡

*From the Center for Health Care Evaluation/HSR&D Field Program, VA Palo Alto Health Care System, Palo Alto, and the Department of Health Research and Policy, Stanford University, Stanford, California.

†From the Roudenbush VA Medical Center, Indiana University School of Medicine, and Regenstrief Institute for Health Care, Indianapolis, Indiana.

‡From the Department of Medicine, University of California, San Francisco, California.

Address correspondence to: Dr Piette, Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park Division (152), 795 Willow Rd, Menlo Park, CA 94025. E-Mail: [email protected]

Received April 12, 1999; initial review completed June 23, 1999; accepted September 8, 1999.

Abstract

Objective.

We evaluated the impact of automated telephone disease management (ATDM) calls with telephone nurse follow-up as a strategy for improving outcomes such as mental health, self-efficacy, satisfaction with care, and health-related quality of life (HRQL) among low-income patients with diabetes mellitus.

Research Design.

This was a randomized, controlled trial.

Subjects.

Two hundred forty-eight primarily English- and Spanish-speaking adults with diabetes enrolled at the time of visits to a county health care system.

Intervention.

In addition to usual care, intervention patients received biweekly ATDM calls with telephone follow-up by a diabetes nurse educator. Patients used the ATDM calls to report information about their health and self-care and to access self-care education. The nurse used patients' ATDM reports to allocate her time according to their needs.

Measures.

Patient-centered outcomes were measured at 12 months via telephone interview.

Results.

Compared with patients receiving usual care, intervention patients at follow-up reported fewer symptoms of depression (P = 0.023), greater self-efficacy to conduct self-care activities (P = 0.006), and fewer days in bed because of illness (P = 0.026). Among English-speaking patients, those receiving the intervention reported greater satisfaction with their health care overall and with the technical quality of the services they received, their choice of providers and continuity of care, their communication with providers, and the quality of their health outcomes (all P <0.042). Intervention and control patients had roughly equivalent scores for established measures of anxiety, diabetes-specific HRQL, and general HRQL.

Conclusions.

This intervention had several positive effects on patient-centered outcomes of care but no measurable effects on anxiety or HRQL.