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Study Design The study was a quasi-experimental patient preference ALLNET ALL0181. Participants with a support person demonstrated significantly greater improvement in long-term adherence than those who participated alone linear regression slopes: Conclusions Despite their multiple challenges in illness self-management, patients with diabetes who are both nonadherent and psychologically distressed may benefit by the incorporation of a support person when they receive assistance via automated telemonitoring. Regular adherence to antihyperglycemic medication is, by far, one of the best predictors of long-term glycemic control.

While significant others often assist patients with managing their diabetes, they are at elevated risk for caregiver burnout and may not have the information they need to be fully effective. This study tested the hypothesis that patients with diabetes who choose to involve a support person in their automated telemonitoring program for self-management assistance demonstrate greater improvement in medication adherence primary outcome than patients who participate in the program without this component.

Because psychological distress is often implicated in nonadherence, 14 and because distressed individuals often attribute their difficulties to insufficient ALLNET ALL0181 support, 1516 we also examined whether distressed patients would benefit most from having this extra support. We excluded patients with diagnoses indicating cognitive impairment or severe mental illness and those who lived in a supervised residential facility. After we mailed potential participants an introductory letter, we screened them by telephone and obtained their written informed consent by mail.

Baseline Assessment Research personnel conducted baseline assessments by telephone before patients began the IVR telemonitoring program. In lieu of an established MCS cutoff, we classified participants as distressed if their score fell ALLNET ALL0181 least one standard deviation below the population mean, i.


Finally, we measured long-term self-reported medication adherence with the well-validated Morisky Medication Adherence Scale MMASon which higher scores reflect lower adherence. Each ALLNET ALL0181 that a call was scheduled i.


Patients received tailored self-management messages based on their responses. The wording of questions and self-management educational messages was developed with input from experts in diabetes education, endocrinology, primary care, and automated telemonitoring service design. Further details of call content and flow can be obtained by contacting the corresponding author. The difference in duration was due to our mid-project design decision to extend the duration of participation in the program based upon initial results including positive patient ALLNET ALL0181 and indications that program benefits might continue accruing beyond three months. How often would you say you took your diabetes medicine exactly as prescribed ALLNET ALL0181 past week?

Patient Self-Management Messages As noted above, a diverse library ALLNET ALL0181 self-management support messages was developed by a multidisciplinary panel in order to ensure that the messages were engaging, clinically appropriate, easy to understand, and likely to be effective. When patients reported a difficulty in an IVR-assessed area, they heard a problem-specific self-management support message such as: If you sometimes forget to take your medicine, then consider buying a daily pill dispenser to help you keep track of when you should take your pills. If you already have a pill dispenser, then leave it out on your counter or table where you will see it often. Alternatively, when patients reported doing well, they heard a positive acknowledgement message such as: Clinician Notifications When patients reported either significant medication nonadherence i.

Based upon clinician input, the thresholds for generating notifications were selected so as to have a low false-positive ALLNET ALL0181, provide actionable information, and efficiently use human resources for follow-up without overburdening clinicians with false alarms. Before the program began, CPs underwent DVD-based training on providing diabetes self-management support and communicating effectively with the patient as well as with any of his or her pre-existing caregivers. For areas in which the patient responded favorably, the report included suggestions on how the CP might reinforce this pattern. For example, [name] reported that she skipped taking her usual diabetes medication at least once during the week before the call.


Although many diabetes patients skip their medication every now and then, this is not advised unless under the direction of a physician. Please contact [name] for more information about her use of diabetes medication, and any reasons for skipping it. You may be able to suggest a simple solution, such as setting ALLNET ALL0181 medication reminders, or urging her to refill her prescription. Other ALLNET ALL0181, the reasons for skipping medication can be more complicated.

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These can include: Data ALLNET ALL0181 Data were analyzed using Stata v. The primary outcome variable was medication adherence, which was measured in two ways: The first set of analyses tested for change in MMAS from baseline to post-intervention. Specifically, we conducted mixed-model linear regression analyses with restricted maximum likelihood estimation.

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These intent-to-treat analyses included all available observations, and missing post-intervention scores were imputed by ALLNET ALL0181 baseline scores forward. Initial models included trial arm participated with CP [CP arm] versus participated alone [control arm]baseline distress as measured by the MCS distressed versus non-distressedand time baseline versus post-interventionas well as their three-way and two-way interactions. Non-significant two-way interactions were removed from the model if the three-way interaction was removed due to non-significance. All main-effect terms were retained, regardless of their significance, in order to adjust final models. To investigate the process of change in patient adherence at the weekly level, we used logistic regression to analyze the factorial effects of distress, arm, and week on the probability of IVR-reported nonadherence.

All available observations were analyzed, but missing week-level data were not imputed.

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All analyses were adjusted for program duration three vs. When significant interactions between time ALLNET ALL0181 arm were identified, we performed stratified analyses in order to clarify the directionality and relative strength of the underlying associations. We also plotted the proportion of patients reporting nonadherence by time, and used locally weighted scatterplot smoothing LOWESS 26 to enhance the interpretability of the weekly data. Seventy percent of participants had four or more chronic conditions in addition to diabetes. Allnet ALL Interface: PCI. ID: 10ec (29 addl. devices) Windows: PCI\VEN_10EC&DEV_ FCC ID: none available.

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