Using Telephonic Care for Managing Diabetes. The presentation will focus on a research study that was performed to compare the effectiveness of telephonic and print intervention over a period of one year with the aim of improving the control of diabetes among low-income urban dwellers. The study was developed at the Einstein Diabetes Research and Training Center in collaboration with the workers’ union insurance plans. Just as the name suggests, telephonic care is a practice where members of the healthcare team help their patients over a phone.
A total of 526 participants of Hispanic, foreign and African origins were included in the randomized trial. Each of these individuals had annual family incomes of less than $30. For one to be an eligible participant in the study, they had to be above the age of 30 years and be under the stipulated insurance plan.
The baseline median A1C value was determined at 8.6% and insulin provided to 24% of those who took part in the study. Change in medication adherence over the period of one year that the research was conducted was associated with a significant rise in the health status among those that took part (Ratanawongsa et al. 2012). The results were compared with those who did not receive insulin therapy. Telephonic interventions aimed to promote optimal medical treatment and promote a quick recovery among individuals on the verge of developing complications such as neuropathy, retinopathy, and nephropathy. It was found out that there were no diabetes self-care activities that correlated with a change in A1C. The management of diabetes takes several courses to yield the desired results. With telephonic care, the practitioners can implement most if not all of the interventions that had been prescribed. Writing prescriptions is an easy task, but physicians and other members of the healthcare team should be concerned about the ability of the patients to put the orders into action. For this reason, telephonic care comes in to practice to assist the individuals in obtaining the required ingredients in the management of diabetes (Odnoletkova et al. 2016). It is only through such an interactive forum that the practitioner may devise ways in which the specific individuals can be assisted to live with their illnesses.
Improvement of the glycemic control among those with type II diabetes mellitus results in a significant reduction in the risk for complications associated with the disease. Despite the fact that effective therapies for the management of diabetes have been developed, the treatment goals among the minority as well as the low-income groups are never achieved. It is a fact that these individuals find it difficult to perform routine self-management besides engaging in activities that promote metabolism of sugar in the bloodstream. Diabetes affects a large population with a low socio-economic status. As such, it would be correct to assert that people with diabetes and fall in this category will be less bothered about the health choices that they make. According to Ratanawongsa et al. (2012); critical scientific reviews indicate that interventions to improve glycemic control among adults include screening for the complications and laboratory tests, behavioral practices that will enhance the levels of glucose as well as training on self-management. It should be noted that ineffective control of diabetes would lead to the development of other cardiovascular complications such as myopathies and hypertension. For this reason, it is necessary that patients be assisted in making better decisions to maintain improved health statuses.
All the interventions provided can best be achieved among people with stable incomes and literacy levels. The study found out that the use of telephonic interventions improved diabetes self-care and the health outcomes (Ratanawongsa et al. 2012). The nurses were trained to ask specific questions that aimed at helping them assess the situation in their homes, and if possible refer them to a proper provider of healthcare instead of sending them to an emergency facility or a clinic. The move would not only decongest the few services available, but also care is provided in the same environment that people spend most of their time. Telephonic interventions enhance adherence to self-care practices by the provision of information to people under real-world conditions (Mattke, Mengistu, Klautzer, Sloss & Brook, 2015). The approach was implemented by highly trained practitioners who not only made automated calls made regular follow-ups to people that seemed not to benefit from the interventions.
It should, however, be noted that the efficacy of telephonic interventions had not been established due to the availability of numerous new pharmaceutical agents and combinations of type II diabetes medications. Other than the standard medical care and patient education that have formed the basis of diabetes management for a long time, the initiative by health practitioners to include telephonic interventions provide coaching and motivation that is required to reinforce the activities that have been presented (Wolf, Seligman, Davis, Fleming, Curtis, Pandit, Parker, DeWalt, 2014). It has been mentioned before that the study was conducted among adults with low incomes. The majority if not all of the complications related to diabetes are as a result of failure to adhere to dietary and medication therapies. Individuals must be provided with the different approaches that they can use to make sure that they do not deviate from practicing healthy living habits despite the fact that their endocrine system has been hampered.
Eligible participants could receive up to ten calls within a period not exceeding six weeks for the one year that the study took. The health educators who took part in the survey made calls that were focused on the medication and lifestyle changes by emphasizing incorporation of a healthy diet and physical activity. The interventions employed revolved around problem-solving, goal setting, and communication skills and preplanning for the medical visits. The aim of telephonic care to empower individuals on self-efficacy measures using social-ecological approaches. A manual was used to guide the content of telephone calls, although each person had the option of choosing the topic for any call that they received. At the end of the study, each participant would be provided with high-quality self-management through their emails.
From the results of the study, it is evident that education on diabetes self-management proved to have more considerable success when it was carried over a prolonged period (Wolf et al. 2014). A one-year period would not provide an accurate presentation of the facts when the various dynamics are taken into consideration. The telephonic care intervention was found to be more feasible especially among people who had difficulties in accessing diabetes-related services. Also, the response would be more successful when the improvement of A1C levels when there was a synergistic collaboration between the financer of the service and practitioners providing care. The teams involved in the care of diabetic patients must channel all their efforts towards improving the quality of lives of the people affected.
References
Mattke, S., Mengistu, T., Klautzer, L., Sloss, E. M., & Brook, R. H. (2015). Improving Care for Chronic Conditions: Current Practices and Future Trends in Health Plans Programs. Santa Monica, Calif: RAND Corporation.
Odnoletkova, I., Goderis, G., Nobels, F., Fieuws, S., Aertgeerts, B., Annemans, L., & Ramaekers, D. (June 01, 2016). Optimizing diabetes control in people with Type 2 diabetes through nurse-led telecoaching. Diabetic Medicine, 33, 6, 777-785.
Ratanawongsa, Neda, Handley, Margaret A, Quan, Judy, Sarkar, Urmimala, Pfeifer, Kelly, Soria, Catalina, & Schillinger, Dean. (2012). Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol. (BioMed Central Ltd.) BioMed Central Ltd.
Wolf, M. S., Seligman, H., Davis, T. C., Fleming, D. A., Curtis, L. M., Pandit, A. U., Parker, R. M., … DeWalt, D. A. (January 01, 2014). Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention. Journal of General Internal Medicine, 29, 1, 59-67
