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Objective: To assess self‐reported financial strain and persistence in asking treatment‐ and medication‐related questions in relation to medication nonadherence. Method: Data were analysed from a cross‐sectional study of adults with diabetes, hypertension or both in central Texas in 2013. Measures of medication nonadherence in the past 12 months, financial strain and patients' persistence in asking treatment‐ and medication‐related questions were identified. Medication nonadherence resulting from cost, transportation or work was compared with medication nonadherence resulting from other reasons. Binary and multinomial regression models were fitted to identify factors associated with medication nonadherence among the respondents. Key findings: In the bivariate model, medication nonadherence from any cause was significantly associated with financial strain, not asking questions about treatments or medications, and all demographic characteristics. However, in the multinomial model, medication nonadherence resulting from cost, work or transportation was only associated with not asking medication‐related question about financial strain, lack of health insurance, age and gender. This was true for nonadherence resulting from other reasons except that ethnicity was significant while gender was not. Conclusions: While removing financial strain could aid medication adherence, clinicians should also encourage patients to be persistent in asking questions about their medications until they understand the purpose for taking them. Our findings have implications for empowering patients to be more proactive in enhancing their adherence to medications. [ABSTRACT FROM AUTHOR]

The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses. ( Population Health Management 2014;17:112-120) [ABSTRACT FROM AUTHOR]

Background Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes selfcare interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. Methods We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged =18 years and whose last measured HbA1c was =7.5% (=58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multispecialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. Results Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory subanalysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. Conclusions Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. [ABSTRACT FROM AUTHOR]

Objective: To determine whether there are any age-related disparities in the frequency of provision of counseling and education for diabetes care in a large HMO in Central Texas.Methods: EMR search from 13 primary care clinics on patients aged ≥18 years (n=1300) who had been diagnosed with type 2 diabetes.Results: There were no significant age differences in the frequency of provision of counseling about HBGM, diet, smoking or diabetes education. However, there were significant age differences in the provision of exercise counseling. Patients aged ≥75 were significantly less likely to have been provided exercise counseling than those aged <65 (adjusted OR=0.60; 95% CI=0.37-0.98). The mean HbA1c for patients aged ≥75 and 65-74 were significantly lower than that of patients aged <65 (8.9 vs. 9.0 vs. 9.7; P<0.001).Conclusion: While age-related variations in self-management protocols were not found, the provision of formal diabetes education was low (29.4%). The persistence of key risk factors in later life (e.g., obesity) underscores the need for better self-management protocols for older adults.Practice Implications: Additional efforts on strategies to increase counseling about lifestyle habits and diabetes self-management care by appropriate health care providers is needed. Diabetes counseling should be individually tailored in older population. [ABSTRACT FROM AUTHOR]

Although diabetes management remains an important problem, little is known about the effectiveness of employing emerging information technologies to enhance self-management strategies in order to improve diabetes care and patient outcomes. This report reviews the use of a community-based participatory research (CBPR) approach with user feedback to understand the feasibility of introducing the personal digital assistant (PDA) as a self-management tool for diabetes management. We focused on problem identification, intervention selection, and methodological issues. Both physician and patient perspectives are addressed. A search of electronic medical records helped to identify diabetes as a major clinical issue for primary care physicians in an integrated group practice. Physicians subsequently identified technological innovations as a promising tool to enhance patient outcomes. User feedback data confirmed the usefulness of using PDAs to assist patients to keep track of their appointments, physical activity, dietary intake, medication use, and daily blood glucose readings. While those with more computer experience caught on quicker, even some of those with limited computer experience were able to draw some benefit. Needed adaptations for greater success with this technological innovation in a wider range of patients were identified. Implementation of new technological approaches in disease management can benefit from a CBPR framework that addresses factors affecting both physician and patient acceptance and uptake. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization. Methods: Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization. Results: Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p =0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm. Conclusion: CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM. Practice implications: Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients. [Copyright &y& Elsevier]