title: Use of telephone care in a cardiovascular disease management programme for type 2 diabetes patients in Santiago, Chile.
abstract: OBJECTIVE
  In 2004, the Chilean National Ministry of Health instituted a cardiovascular disease (CVD) management programme aimed at improving diabetes care among patients treated in the public healthcare system. We sought to identify the characteristics of patients participating in the CVD programme and the feasibility of extending its reach through structured nurse telephone contacts between outpatient encounters.
  
  
  METHODS
  We surveyed 569 low-income adults with type 2 diabetes treated in public clinics of Santiago, to assess patients' participation in the CVD programme and willingness to use telephone care services. Surveys were linked to information from medical records.
  
  
  RESULTS
  One-third of patients met the target of two visits to the CVD programme in the previous 6 months, and an additional 32% made more than three visits. Use of the CVD programme was associated with greater patient satisfaction, even after controlling for potential confounders. However, 27% of patients had inadequate programme contact, and many of these patients were in poor health. Many CVD programme participants reported difficulties with lifestyle changes, and greater contact with the CVD programme was not associated with healthier behaviours. Most patients (95%) reported telephone access and 37% had used the telephone to contact their clinic. The majority of patients would be willing to use telephone care for additional behaviour change and emotional support. Patients with fewer CVD programme visits were particularly likely to report willingness to use telephone care.
  
  
  CONCLUSIONS
  Clinic-based CVD disease management services reach a large number of socio-economically vulnerable Chileans with diabetes. However, barriers to access remain, and planned telephone care services may increase the reach of self-management support.
authors.affiliation: VA Ann Arbor Healthcare System and University of Michigan Diabetes Research and Training Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Ilta
authors.initials: I
authors.lastname: Lange
authors.forename: Michelle
authors.initials: M
authors.lastname: Issel
authors.forename: Solange
authors.initials: S
authors.lastname: Campos
authors.forename: Claudia
authors.initials: C
authors.lastname: Bustamante
authors.forename: Jaime
authors.initials: J
authors.lastname: Sapag
authors.forename: Fernando
authors.initials: F
authors.lastname: Poblete
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Annette M
authors.initials: AM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000451:nursing / Q000517:prevention & control*; D002677:Chile; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000451:nursing / Q000517:prevention & control*; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D013689:Telephone; D014505:Urban Population