Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study
| Autor: | Lisa L.H. Nguyen, Erin Rogers, Sneha R Aidasani, Lu Hu, Binhuan Wang, Agnes Park, Dana N Moloney, Natalie Levy, Mary Ann Sevick, Natasha A. Orzeck-Byrnes, Aisha T. Langford |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Telemedicine medicine.medical_specialty Adolescent Referral Staffing 030209 endocrinology & metabolism Health Informatics Type 2 diabetes law.invention Young Adult 03 medical and health sciences Underserved Population 0302 clinical medicine Patient satisfaction Randomized controlled trial law medicine Humans Hypoglycemic Agents Insulin Generalizability theory 030212 general & internal medicine medically underserved area Aged Text Messaging Original Paper business.industry Health Plan Implementation Middle Aged medicine.disease healthcare disparities Diabetes Mellitus Type 2 Physical therapy Female business diabetes mellitus type 2/drug therapy insulin/long-acting/administration & dosage |
| Zdroj: | Journal of Medical Internet Research |
| ISSN: | 1438-8871 |
| Popis: | Background: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective: This implementation study examined MITI’s transition into real-world settings. To understand MITI’s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program—129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P |
| Databáze: | OpenAIRE |
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