Telecare of Diabetes 2, Research Paper Example

Findings from a randomized clinical trial

The foregoing discussion looks at a randomized controlled trial (RCT), conducted by Dale, et al. (2009) in the United Kingdom of inadequately controlled type-2 Diabetes outpatient telephone intervention or ‘telecare.’ The test was designed to record self-reported, peer reported, and specialist reported findings on the efficacy and impact to clinical outcomes. The trial follows the UK Medical Research Council (MRC) framework for the development and evaluation of complex interventions, and is intended to increase self-treatment in relation to lifestyle behaviors and medication adherence. Control for the study was put into comparison with routine care and nurse telecare provision without self-care provision model. Telecare support within the trial was intended to augment routine care through motivation of adherence to general practitioner or practice nurse advice to day 5, followed by a ‘standard care package’ in four day increments from day 7 to day 150.

Validity of the findings in the study is measured against random assignment of patients recruited from 40 general practices out of 114 invited to participate. Recruitment commenced in December 2004 and was completed in April 2006. The extended recruitment process was due to unforeseen coordination activities. This impacted general practitioner contract status and system of remuneration on the project. Revised randomization scale of 40:40:20 ratio for patients randomized to control (CG), peer support (PS) and diabetes specialist nurse (DSN) was introduced into the peer telecare support arm of the trial. Follow-up assessment is a core component to the study, in that chronic care options, and especially self-efficacy can be reported in the context of routine and other standardized care interventions. Out of 231 participants, one hundred percent completed the study. There was no random assignment concealed from data collectors, or blind subjects or providers in the study.

Statistical outcomes analysed by way of linear mixed effect models for repeated measures, and adjusted for baseline measurements at 2 and 6 months. Reporting on patients all include at least one baseline measurement. The primary measurement in the trial employs the Diabetes Management Self Efficacy Score (DMSES) for patient self-reporting. The secondary methodological consideration, utilized HbA1c blood specimen assessment; and according to local protocols either by practice staff or by phlembotomy service. There was no change in standardization during the test period. Patient and telecare supporter satisfaction and experience evaluated. Demonstrated outcomes to the trial included comparison of test subjects analyzed in comparison with control group (CG) toward interpretation of superiority of peer supported telecare compared to absence of such provision in CG reporting.

Participants in the study were provided with written information as well as invited to a preliminary appointment with a practice nurse prior to testing. The impetus for the recruitment within routine practice was to maintain consistency with traditional protocol, and also to offer such interventions as prescribed change in treatment and recommendations toward behavioral change necessary for inclusion in the study. Baseline data were collected pre-randomization. Patients had to show HbA1c greater than 8.0% and advice in mitigation of glycated haemoglobin by way of behavior change was solicited in all cases, regardless of changes to prescribed tablet based therapies.

Demographic constitution in the study is distributed over a range of subjects, but with density in mostly White, British males and females between 51-69 years of age. Median diabetes duration is captioned at 1-15 years, with a high tendency toward non-smoking behaviors at 71%, and reported medication treatment over all other combined treatments at 46%. The sample size of the study allowed for statistical significance in terms of intervention size and meaning, with confidence level ratios most revealed most prevalent in the DMSES behavioral model in the study, illustrated in Table 1.

Practice implications to the study offer conclusive results that point to the feasibility of the trial’s telecare design for support of patients with type-2 Diabetes for targeted provision in general practitioner patient care if a similar framework for implementation is available. Acceptability of the model by patients was high, but the findings from the study also indicate that benefit to patients in the research may be anecdotal rather than scientific, and therefore risky in that the treatment might not applicable to all patients in a clinical setting. Training and ongoing supervision of telecare supporters was cited as the primary concern, as inconsistency might impinge upon the fidelity of the intervention.

Works Cited

Dale, J. et al. (2009). Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. Patient Education and Counseling, 75, 91-98.