title: Promoting self-management in diabetes: efficacy of a collaborative care approach.
abstract: Diabetes is a leading cause of death and is estimated to cost the United States 90 billion dollars annually. Increasing patient self-management skills has been shown to improve outcomes in patients with Type II diabetes. Promotion of shared decision-making between patient and provider is a core element of collaborative care and is especially well suited for increasing patient self-management. Research trials to date have been limited in demonstrating how self-management promotion can be fully integrated into primary care practices. Demonstration of the impact of this approach is needed. This study involves 22 randomly assigned physicians across three family medicine clinics to either provide usual care or work with a part-time collaborative care therapist in their clinic serving as an outreach health coach for their diabetic patients. Each outreach health coach met with each physician in the intervention group to identify patients most in need of intervention, sent identified patients a video on diabetes management, and called to encourage video viewing and discuss any patient-perceived barriers to self-management. Initial markers of patient activation in self-management, patients' video-viewing behavior, and health care encounters in the subsequent 6 months were compared between groups. Results showed that patients targeted by an outreach health coach were more likely to view the video, be seen by their primary care physician (PCP) within 6 months, and have disease-relevant laboratory tests performed than patients receiving usual care from their PCP (p < .05). This approach, linking PCPs with collaborative care staff, is viewed as expanding the engagement of PCPs with the collaborative team for superior patient health outcomes.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego (UCSD), CA 92093, USA. bseieber@ucsd.edu
authors.forename: William
authors.initials: W
authors.lastname: Sieber
authors.forename: Alita
authors.initials: A
authors.lastname: Newsome
authors.forename: Dustin
authors.initials: D
authors.lastname: Lillie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005194:Family Practice; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D012648:Self Care / Q000379:methods*; D014481:United States; D014743:Videotape Recording