scholarly journals Cost-effectiveness of facilitated access to a self-management website (HeLP-Diabetes) compared to usual care for patients with Type 2 Diabetes: a randomised-control trial

2017 ◽  
Author(s):  
Jinshuo Li ◽  
Steve Parrott ◽  
Michael Sweeting ◽  
Andrew Farmer ◽  
Jamie Ross ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Self Management ◽  
Randomised Control Trial

scholarly journals Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Jinshuo Li ◽  
Steve Parrott ◽  
Michael Sweeting ◽  
Andrew Farmer ◽  
Jamie Ross ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Usual Care ◽  
Controlled Trial ◽  
Self Management ◽  
Primary Analysis ◽  
Randomized Controlled

BACKGROUND Type 2 diabetes mellitus is one of the most common long-term conditions, and costs health services approximately 10% of their total budget. Active self-management by patients improves outcomes and reduces health service costs. While the existing evidence suggested that uptake of self-management education was low, the development of internet-based technology might improve the situation. OBJECTIVE To establish the cost-effectiveness of a Web-based self-management program for people with type 2 diabetes (HeLP-Diabetes) compared to usual care. METHODS An incremental cost-effectiveness analysis was conducted, from a National Health Service and personal and social services perspective, based on data collected from a multi-center, two-arm individually randomized controlled trial over 12 months. Adults aged 18 or over with a diagnosis of type 2 diabetes and registered with the 21 participating general practices (primary care) in England, UK, were approached. People who were unable to provide informed consent or to use the intervention, terminally ill, or currently participating in a trial of an alternative self-management intervention, were excluded. The participants were then randomized to either usual care plus HeLP-Diabetes, an interactive, theoretically-informed Web-based self-management program, or to usual care plus access to a comparator website containing basic information only. The participants’ intervention costs and wider health care resource use were collected as well as two health-related quality of life measures: the Problem Areas in Diabetes (PAID) Scale and EQ-5D-3L. EQ-5D-3L was then used to calculate quality-adjusted life years (QALYs). The primary analysis was based on intention-to-treat, using multiple imputation to handle the missing data. RESULTS In total, 374 participants were randomized, with 185 in the intervention group and 189 in the control group. The primary analysis showed incremental cost-effectiveness ratios of £58 (95% CI –411 to 587) per unit improvement on PAID scale and £5550 (95% CI –21,077 to 52,356) per QALY gained by HeLP-Diabetes, compared to the control. The complete case analysis showed less cost-effectiveness and higher uncertainty with incremental cost-effectiveness ratios of £116 (95% CI –1299 to 1690) per unit improvement on PAID scale and £18,500 (95% CI –203,949 to 190,267) per QALY. The cost-effectiveness acceptability curve showed an 87% probability of cost-effectiveness at £20,000 per QALY willingness-to-pay threshold. The one-way sensitivity analyses estimated 363 users would be needed to use the intervention for it to become less costly than usual care. CONCLUSIONS Facilitated access to HeLP-Diabetes is cost-effective, compared to usual care, under the recommended threshold of £20,000 to £30,000 per QALY by National Institute of Health and Care Excellence. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN) 02123133; http://www.controlled-trials.com/ISRCTN02123133 (Archived by WebCite at http://www.webcitation.org/6zqjhmn00)

Effectiveness and acceptability of a text message intervention (DTEXT) on diabetes control and self-management for people with type 2 diabetes: A randomized controlled trial.

2020 ◽  
Author(s):  
Karen Waller ◽  
Susan Furber ◽  
Adrian Bauman ◽  
Margaret Allman-Farinelli ◽  
Paul van den Dolder ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mobile Phone ◽  
Usual Care ◽  
Text Message ◽  
Diabetes Control ◽  
Self Management ◽  
Randomised Control Trial ◽  
Control Group ◽  
Text Message Intervention

Abstract Background Mobile phone text message interventions have the potential to improve the health of people with type 2 diabetes at a population level. This study aimed to determine the effectiveness and acceptability of a mobile phone text message intervention (DTEXT) on diabetes control and self-management behaviours for Australian adults with type 2 diabetes. Methods A two-armed parallel non-blinded randomised control trial was conducted with 395 community dwelling adults with type 2 diabetes and HbA1c ≥7.0% (53 mmol/mol). Block randomisation occurred after completion of baseline measures. The control group received usual care, the intervention group received usual care and the automated six month text message intervention (daily messages for months 1-3, four messages per week for months 4-6). Pathology measures and self-report telephone surveys were assessed using intention to treat analysis. Generalised estimating equations determined between group changes in HbA1c at 3 and 6 months. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication adherence and program acceptability. Results No significant difference was observed between the intervention (n=197) or control group (n=198) for HbA1c at 3 months (-0.11%; CI -0.28, 0.07; d= -0.05, p=0.23) or 6 months (-0.13%; CI -0.33, 0.08; d= -0.05, p=0.22). A significant improvement in nutrition was seen with consumption of vegetables at 3 months (0.74 serves/day; 95%CI 0.34, 1.12; d =0.31, p<0.01) and 6 months (0.42 serves/day; 95% CI 0.03, 0.82; d =0.18, p=0.04); fruit at 3 months (0.21 serves/day; 95% CI 0.00, 0.41; d =0.09, p<0.05) and discretionary sweet foods at 3 months (-1.10 times/week; 95% CI -2.03, -0.16; d =-0.47, p=0.02). No other significant effects were seen at 3 months and 6 months. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). Conclusions A mobile phone text message intervention can improve some nutritional behaviours in people with type 2 diabetes, but does not significantly improve HbA1c or other health outcomes. DTEXT provides a highly accepted and potentially scalable form of self-management support that can complement existing diabetes care. Trial Registration Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392. Registered: 23 March 2017.

scholarly journals Cost-Effectiveness Analysis of a Mobile-Based Intervention for Patients with Type 2 Diabetes Mellitus

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jing Li ◽  
Li Sun ◽  
Yabing Hou ◽  
Liming Chen
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Usual Care ◽  
Usual Care Group ◽  
Management Mode ◽  
Care Group

Objective. The aim of this study was to evaluate the cost effectiveness of a mobile-based intervention for patients with type 2 diabetes mellitus (T2DM) and compare it with the usual management mode. Method. A total of 215 patients with T2DM in a tertiary-care hospital specific to diabetes were selected as the study population. This study was conducted from January 1, 2019 to January 1, 2020. Of the 215 patients, 130 were randomly assigned to the mHealth group and 85 were assigned to the usual care group. IBM SPSS 25.0 software was used for descriptive statistics, t tests, chi-square tests, and correlation analyses. Haemoglobin A1c (HbA1c) was the effectiveness parameter adopted. Cost-effectiveness analyses were performed, and incremental cost-effectiveness ratios (ICERs) were calculated. Results. Of the 215 patients with T2DM, the proportion of male patients was 66.0%. The mean age of the patients was 47.2 (SD 9.95). Differences in baseline information were not statistically significant between the two groups ( P > 0.05 ). At the 3-, 6-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than the usual care group, 67.9% versus 46.2% ( P < 0.001 ), 72.4% versus 45.4% ( P < 0.001 ), and 74.6% versus 47.1% ( P < 0.001 ), respectively. The value of HbA1c was positively related to total patient cost, material fee, Western medicine fee, and hospitalization expenses ( P < 0.05 ), with correlation coefficients of 0.202, 0.200, 0.172, and 0.183, respectively. The costs of the mHealth group and usual care group were CNY¥ 1169.76 and CNY¥ 1775.44 per patient/year, respectively. The incremental cost of the mHealth intervention was CNY¥ −605.68 per patient/year. The ICER was CNY¥ −22.02 per patient/year. Conclusion. Compared with the usual care mode, the mHealth management model for patients with T2DM improved the control rate of HbA1c, and the mHealth management mode had better cost effectiveness.

scholarly journals Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Esther du Pon ◽  
Nanne Kleefstra ◽  
Frits Cleveringa ◽  
Ad van Dooren ◽  
Eibert R. Heerdink ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Self Management ◽  
Online Platform ◽  
Randomized Controlled ◽  
Number Of Patients

Online care platforms can support patients with type 2 diabetes (T2DM) in managing their health. However, in the use of eHealth, a low participation rate is common. The Proactive Interdisciplinary Self-Management (PRISMA) program, aimed at improving patients’ self-management skills, was expected to encourage patients to manage their disease through the use of an online platform. Therefore, the objective of the current study was to investigate whether a group education program can improve the use of an online care platform in patients with T2DM treated by primary care providers in the Netherlands. In a randomized controlled trial, patients with T2DM received either PRISMA with usual care or usual care only. During a six-month follow-up period in 2014-2015, usage (number of log-ons and time spent per session) of an online care platform (e-Vita) aimed at improving T2DM self-management was assessed. A training about the functionalities of e-Vita was offered. The sample consisted of 203 patients. No differences were found between the intervention and control groups in the number of patients who attended the platform training (interested patients) (X21=0.58; p=0.45), and the number of patients who logged on at least once (platform users) (X21=0.46; p=0.50). In addition, no differences were found between the groups in the type of users—patients who logged on twice or more (active users) or patients who logged on once (nonactive users) (X21=0.56; p=0.45). The PRISMA program did not change platform usage in patients with T2DM. In addition, only a small proportion of the patients logged on twice or more. Patients probably need other encouragements to manage their condition using an online platform.

scholarly journals Impact of Telehealth Care among Adults Living with Type 2 Diabetes in Primary Care: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 18 (22) ◽  
pp. 12171
Author(s):  
Natalie Robson ◽  
Hassan Hosseinzadeh
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Primary Health Care ◽  
Usual Care ◽  
Meta Analysis ◽  
Self Management ◽  
Primary Health ◽  
Randomised Controlled ◽  
Hba1c Levels

Primary health care physicians are increasingly offering telehealth services to patients not only for its cost and time saving advantages but for the additional benefits telehealth can provide for patients with type 2 diabetes (T2D) such as improved self-management behaviours. To support the development of telehealth based T2D clinical care models in primary health care settings, a narrative synthesis and meta-analysis of randomised controlled trial studies was completed for 29 studies that evaluated the effect of one or more types of telehealth interventions on HbA1c levels compared to usual care alone. Results from the random effects meta-analysis demonstrated that telehealth interventions had a stronger influence on HbA1c compared to usual care with a mean difference in HbA1c \% −0.18 (CI −0.35, −0.01), p = 0.04. Results from the subgroup meta-analysis demonstrated that telehealth interventions, when grouped by type of telemonitoring (mHealth and telephone communication), all have a stronger effect on lowering HbA1c levels; however, none of these findings were significant. Key findings from this review demonstrate that telehealth interventions that address T2D self-management behaviours and have higher levels of health care provider engagement, have greater effects on lowering HbA1c levels compared to usual care alone.

scholarly journals Impact of Motivational Interviewing on Self-Management in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Man Kin Wong ◽  
Sai Yip Ronald Cheng ◽  
Tsun Kit Chu ◽  
Fung Yee Lam ◽  
Shiu Kee Lai ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Behaviors ◽  
Usual Care ◽  
Diabetic Control ◽  
Self Management ◽  
Randomized Controlled ◽  
Patients With Diabetes ◽  
Care Outcomes

BACKGROUND The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. OBJECTIVE This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. METHODS An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. RESULTS This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. CONCLUSIONS MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. CLINICALTRIAL Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15709

scholarly journals Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial

10.2196/16665 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e16665 ◽  
Author(s):  
Heather M Young ◽  
Sheridan Miyamoto ◽  
Madan Dharmar ◽  
Yajarayma Tang-Feldman
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Usual Care ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Management ◽  
Randomized Controlled ◽  
Mhealth Technology

Background Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. Objective This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. Methods This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. Results We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). Conclusions We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. Trial Registration ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176

scholarly journals Cost Effectiveness Of Type 2 Diabetes Patients: A Research Framework

2020 ◽  
Vol 8 (4) ◽  
pp. 116-131
Author(s):  
SUZANA SULAIMAN ◽  
NAZREEN SAHOL
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Cost Effectiveness ◽  
Healthcare Provider ◽  
Operation Management ◽  
Self Management ◽  
Value For Money ◽  
Health Complications ◽  
Diabetes Patients

The growing of Metabolic Syndrome (MS) has contributed to higher risk and costs in managing Type 2 Diabetes patients. Diabetes patients are exposed to develop serious health complications. It can lead to related diseases affecting heart, eyes, kidneys, nerves and teeth. There is no proper framework on operation management and cost effectiveness in treating diabetes patients in Malaysia. Hence, it demanded on the elements and associated costs incurred by both healthcare provider and patients. This paper adopted five stages in analyzing its relevant literatures. Cost effectiveness, healthcare provider, operation management and self-management were the literatures studied. It also highlighted on management accounting gained its relevancy and contribution towards health industry. As a result, a cost effectiveness of Type 2 Diabetes framework was developed. Cost effectiveness is a key component in determining value for money. This framework provides the value for money model for Type 2 Diabetes patients. The framework clearly provides the components of cost-effectiveness and 3Es: Economy, Efficiency; Effectiveness. Objectives, resources, input, processes, output, outcomes (intended or intended) and other influences are the components.

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