Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention

Allison A. Lewinski, Uptal D. Patel, Clarissa Diamantidis, Megan Oakes, Khaula Baloch, Matthew J. Crowley, Jonathan Wilson, Jane Pendergast, Holly Biola, Leigh Boulware, Hayden B. Bosworth

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. OBJECTIVE: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. METHODS: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. RESULTS: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. CONCLUSION: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU).

Original languageEnglish (US)
Pages (from-to)e12541
JournalJournal of medical Internet research
Volume21
Issue number4
DOIs
StatePublished - Apr 9 2019
Externally publishedYes

Fingerprint

Telemedicine
Self Care
Blood Pressure
Hypertension
Text Messaging
Electronic Health Records
Kidney
Southeastern United States
Population
Education
Patient-Centered Care
Cell Phones
Population Control
Health
Diabetic Nephropathies
Feasibility Studies
Poverty
Telephone
Social Class
Health Care Costs

Keywords

  • cardiovascular diseases
  • diabetes mellitus type 2
  • hypertension
  • professional-patient relations
  • renal insufficiency
  • telemedicine
  • vulnerable populations

ASJC Scopus subject areas

  • Health Informatics

Cite this

Addressing Diabetes and Poorly Controlled Hypertension : Pragmatic mHealth Self-Management Intervention. / Lewinski, Allison A.; Patel, Uptal D.; Diamantidis, Clarissa; Oakes, Megan; Baloch, Khaula; Crowley, Matthew J.; Wilson, Jonathan; Pendergast, Jane; Biola, Holly; Boulware, Leigh; Bosworth, Hayden B.

In: Journal of medical Internet research, Vol. 21, No. 4, 09.04.2019, p. e12541.

Research output: Contribution to journalArticle

Lewinski, AA, Patel, UD, Diamantidis, C, Oakes, M, Baloch, K, Crowley, MJ, Wilson, J, Pendergast, J, Biola, H, Boulware, L & Bosworth, HB 2019, 'Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention', Journal of medical Internet research, vol. 21, no. 4, pp. e12541. https://doi.org/10.2196/12541
Lewinski, Allison A. ; Patel, Uptal D. ; Diamantidis, Clarissa ; Oakes, Megan ; Baloch, Khaula ; Crowley, Matthew J. ; Wilson, Jonathan ; Pendergast, Jane ; Biola, Holly ; Boulware, Leigh ; Bosworth, Hayden B. / Addressing Diabetes and Poorly Controlled Hypertension : Pragmatic mHealth Self-Management Intervention. In: Journal of medical Internet research. 2019 ; Vol. 21, No. 4. pp. e12541.
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TY - JOUR

T1 - Addressing Diabetes and Poorly Controlled Hypertension

T2 - Pragmatic mHealth Self-Management Intervention

AU - Lewinski, Allison A.

AU - Patel, Uptal D.

AU - Diamantidis, Clarissa

AU - Oakes, Megan

AU - Baloch, Khaula

AU - Crowley, Matthew J.

AU - Wilson, Jonathan

AU - Pendergast, Jane

AU - Biola, Holly

AU - Boulware, Leigh

AU - Bosworth, Hayden B.

PY - 2019/4/9

Y1 - 2019/4/9

N2 - BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. OBJECTIVE: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. METHODS: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. RESULTS: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. CONCLUSION: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU).

AB - BACKGROUND: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. OBJECTIVE: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. METHODS: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. RESULTS: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. CONCLUSION: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU).

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KW - diabetes mellitus type 2

KW - hypertension

KW - professional-patient relations

KW - renal insufficiency

KW - telemedicine

KW - vulnerable populations

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