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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1003 — A Comparison of Low- and High-Intensity Monitoring in Veterans with Co-Morbid Diabetes and Hypertension

Wakefield BJ (Harry S Truman Memorial Veterans Hospital), Holman JE (Iowa City VA HSR&D Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP)), Ray A (CRIISP), Scherubel M (CRIISP), Simons M (Iowa City VAMC), Kienzle MG (Carver College of Medicine, University of Iowa), Hillis S (CRIISP), Rosenthal GE (CRIISP)

Objectives:
The primary objective of this study was to evaluate the efficacy of remote monitoring with nurse care management in improving outcomes in veterans with co-morbid diabetes and hypertension, the two most common chronic conditions seen in Veterans Affairs Primary Care clinics.

Methods:
302 subjects were randomized to three groups: low-intensity monitoring plus nurse care management intervention (n=102); high-intensity monitoring plus nurse care management intervention (n=93); and usual care (n=107). In both intervention groups, patients transmitted vital signs daily from home. In addition, the low intensity group answered two general health questions; the high intensity group responded to a complete range of questions focused on diabetes and hypertension, and received educational tips using a home messaging device. The intervention groups participated in the protocol for 6 months following enrollment.

Results:
Most subjects were male (98%) Caucasians (96%) with a mean age of 68 years (range 40-89 years). Preliminary results are reported. The three groups were comparable at baseline for mean HbA1c (7.1, 7.1, 7.2) and systolic blood pressure (134, 139, 134) for control, high, and low intensity respectively. At 6 months the control group mean HbA1c was unchanged but the high- and low-intensity groups had dropped significantly (to 6.7 and 6.8 respectively) (F=4.24, p=0.02). For systolic BP there was a significant time by group interaction, i.e., control and low-intensity subjects had small changes, but the high-intensity subjects dropped by 7 points (F=6.01, p=0.003). Medication adherence (Morisky) improved significantly over time for all three groups (F=3.91, p=0.05), but there were no differences among the groups.

Implications:
Preliminary results indicate that the intervention was effective in improving HbA1c and this effect was more pronounced in the high intensity group. Only the high intensity group showed an improvement in systolic blood pressure.

Impacts:
Although remote monitoring offers a number of theoretical advantages, most projects have focused on single disease populations, e.g., heart failure or mental illnesses. Furthermore, few controlled clinical trials have investigated varying the intervention dose. Since remote monitoring may hold the most promise for individuals with multiple chronic illnesses, these preliminary results are promising and provide data to design tailored remote monitoring interventions for primary care patients.


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