High-Touch Intervention Yields Success for Patients with Diabetes, Hypertension

Successful North Carolina Study to Roll Out Statewide

DURHAM, N.C., Jan. 19, 2012 /PRNewswire/ -- A new health behavior intervention has been spelling success for North Carolina patients with diabetes and hypertension. The intervention, Cholesterol, Hypertension and Glucose Education, or CHANGE, was piloted in a study led by principal investigator Hayden Bosworth, PhD, at Duke University Medical Center, and rolled out this spring to patients enrolled in the Northern Piedmont Community Care system. The demonstrated success of the program is leading to an expected expansion of the intervention to all North Carolina Medicaid practices in the coming months. 

In the CHANGE intervention, patients recommended by their primary care physicians are called on a monthly basis by nurses who discuss management of their chronic conditions with them. The nurses guide patients through discussion modules on topics ranging from weight, diet and exercise, to medications, side effects, memory, depression, stress, patient-provider interactions and social support. Some topics are discussed at every call, while some are dependent on a patient's needs—a unique model that allows the intervention to be both responsive and flexible.

Regular contact with a real person makes a difference. "We talk with the same patient every month and over time develop real relationships with them," explains CHANGE nurse Pamela Gentry. "They begin to anticipate our calls, writing down questions to ask us. We revisit topics and reinforce what is important, are able to nip problems in the bud, and encourage lifestyle changes that will have a positive impact on their overall health. When someone else answers the phone and says, 'it's your nurse,' we know the patient (and their family) sees a real relationship with us." 

The CHANGE study was focused on African American patients and was developed in response to the significant racial disparities in mortality in relation to cardiovascular disease (CVD). "CVD and diabetes account for over one-third of the mortality difference between African American and white patients," points out Bosworth. "The increased risk for African Americans is due to the fact that Black patients are twice as likely to have more than three CVD risk factors as white patients. CHANGE was designed with this imbalance in mind, and is aimed at improving CVD outcomes in African American adults with diabetes by addressing modifiable risk factors such as systolic blood pressure and LDL cholesterol." 

CHANGE nurses are trained in motivational interviewing techniques and make quarterly reports on patients' progress and medication issues to primary care providers. The CHANGE study, conducted in 2009, enrolled 360 high-risk African American patients with chronic diabetes and hypertension, who had had at least one primary care visit at a participating clinic in the preceding year. Half of the patients received educational materials, and half received monthly telephone calls from a nurse for twelve months, in addition to the educational materials. The CHANGE study has had encouraging results, showing positive changes in patients' adherence to medication regimens, A1C blood sugar levels, blood pressure and weight. 

Fred Johnson, Director of Northern Piedmont Community Care (one of 14 networks that are managed primary care systems for the Medicaid population of North Carolina) had been keeping an eye on the CHANGE study as it progressed. As head of a busy primary care management system with over 60,000 enrollees, he was looking for a responsive intervention that could improve outcomes for his patients and also potentially prevent hospitalization, lowering the Medicaid costs always under scrutiny by the state legislature. "I was skeptical about a phone-based system at first," says Johnson. "It sounded like a boutique sort of service that was not a good fit for my very low-income patients. But then I saw the results with hypertension at some of the study sites, and I knew that this could be the sort of 'bridge' intervention I needed to serve CVD patients of all races. I didn't want to completely abandon my chronic disease self management programs and move strictly to a focus on hospital utilization. So I was searching for a program that was low-maintenance from a resource perspective but could have a wide impact, and CHANGE fit the bill."

Statewide rollout of CHANGE in the coming months will bring the benefits of the program to potentially over one million North Carolina Medicaid recipients. "It's what we've always wanted," says Bosworth.  "Not just to come in and create good data, but to have that data applied in real clinical settings and make an impact."

Funding for the study was provided by Finding Answers: Disparities Research for Change, which evaluates the impact of interventions aimed at closing racial and ethnic gaps in care, with a particular focus on cardiovascular disease, depression and diabetes.                                 

Finding Answers is a national program of the Robert Wood Johnson Foundation at the University of Chicago, which awards and manages research grants totaling $8 million to health care organizations implementing interventions aimed at reducing disparities. The funds are used to evaluate the interventions and their potential for real-world implementation. This initiative encourages health plans, hospitals and community clinics to focus on racial and ethnic disparities as a priority in their quality improvement agendas. To learn more about Finding Answers, visit www.SolvingDisparities.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

Luise Z. Moskowitz
[email protected]
(215) 747-7700


SOURCE Finding Answers