Impact of a novel pharmacist-delivered behavioral intervention for patients with poorly-controlled diabetes: The ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic randomized trial

Autor: Nancy Haff, Sagar Makanji, Saira Jan, Niteesh K. Choudhry, Jennifer Lewey, Eric Wittbrodt, Constance P. Fontanet, Jessica Lee, Julie C. Lauffenburger, Christina A. Ferro, Roya Ghazinouri
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Motivational interviewing
Social Sciences
Type 2 diabetes
030204 cardiovascular system & hematology
Pharmacists
Biochemistry
law.invention
0302 clinical medicine
Endocrinology
Cognition
Randomized controlled trial
law
Diabetes diagnosis and management
Medicine
Psychology
Insulin
030212 general & internal medicine
Medical Personnel
Young adult
Multidisciplinary
Pharmaceutics
Middle Aged
Telephones
Professions
Treatment Outcome
Engineering and Technology
Female
Research Article
Adult
Behavior Control
medicine.medical_specialty
HbA1c
Adolescent
Endocrine Disorders
Science
Decision Making
Pharmacist
Equipment
Motivational Interviewing
Medication Adherence
03 medical and health sciences
Young Adult
Drug Therapy
Diabetes management
Intervention (counseling)
Diabetes Mellitus
Humans
Hypoglycemic Agents
Hemoglobin
Nutrition
Medicine and health sciences
Communication Equipment
Diabetic Endocrinology
Glycated Hemoglobin
Biology and life sciences
business.industry
Cognitive Psychology
Proteins
medicine.disease
Diagnostic medicine
Hormones
Diet
Telephone
Clinical pharmacy
Diabetes Mellitus
Type 2
Metabolic Disorders
People and Places
Physical therapy
Cognitive Science
Population Groupings
business
Neuroscience
Zdroj: PLoS ONE
PLoS ONE, Vol 14, Iss 4, p e0214754 (2019)
ISSN: 1932-6203
Popis: Background Many factors contribute to suboptimal diabetes control including insufficiently-intensive treatment and non-adherence to medication and lifestyle. Determining which of these is most relevant for individual patients is challenging. Patient engagement techniques may help identify contributors to suboptimal adherence and address barriers (using motivational interviewing) and help facilitate choices among treatment augmentation options (using shared decision-making). These methods have not been used in combination to improve diabetes outcomes. Objective To evaluate the impact of a telephone-based patient-centered intervention on glycosylated hemoglobin (HbA1c) control for individuals with poorly-controlled diabetes. Design Two-arm pragmatic randomized control trial within an explanatory sequential mixed-methods design. Subjects 1,400 participants 18–64 years old with poorly-controlled type 2 diabetes. Intervention The intervention was delivered over the telephone by a clinical pharmacist and consisted of a 2-step process that integrated brief negotiated interviewing and shared decision-making to identify patient goals and options for enhancing diabetes management. Main measures The primary outcome was change in HbA1c. Secondary outcomes were medication adherence measures. Outcomes were evaluated using intention-to-treat principles; multiple imputation was used for missing values in the 12-month follow-up. We used information from pharmacist notes to elicit factors to potentially explain the intervention’s effectiveness. Key results Participants had a mean age of 54.7 years (SD:8.3) and baseline HbA1c of 9.4 (SD:1.6). Change in HbA1c from baseline was -0.79 (SD:2.01) in the control arm and -0.75 (SD:1.76) in the intervention arm (difference:+0.04, 95%CI: -0.22, 0.30). There were no significant differences in adherence. In as-treated analyses, the intervention significantly improved diabetes control (-0.48, 95%CI: -0.91, -0.05). Qualitative findings provided several potential explanations for the findings, including insufficiently addressing patient barriers. Conclusions A novel telephone-based patient-centered intervention did not improve HbA1c among individuals with poorly-controlled diabetes, though as-treated analyses suggest that the intervention was effective for those who received it. Trial registration ClinicalTrials.gov NCT02910089
Databáze: OpenAIRE
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