title: Safety events during an automated telephone self-management support intervention.
abstract: BACKGROUND
  Interactive health information technology (HIT) can support the complex self-management tasks for diabetes. However, less is known about between-visit interactions and patient safety among chronic illness patients treated in the outpatient setting.
  
  
  METHODS
  We classified 13 categories for safety events and potential safety events within a larger trial evaluating a multilingual automated telephone self-management support system for diabetes using interactive voice response. Participants could trigger safety concerns by reporting hyperglycemia or hypoglycemia, inability to obtain medications, medication nonadherence and side effects, and needing appointments and/or supplies. We then examined these triggers across patient demographic and health characteristics to determine which patients were most likely to experience safety events.
  
  
  RESULTS
  Overall, there were 360 safety triggers that occurred among 155 participants, which represented 53% of individuals and 7.6% of all automated calls over the 27-week intervention. The most common triggers were for pain or medication side effects (22%) and not checking blood sugars (13%). In adjusted models, race/ethnicity and language were related to safety triggers; Spanish-speaking participants were significantly (p = .02) more likely than English-speaking participants to experience a safety trigger, and black participants were marginally more likely (p = .09) than white participants to experience a safety trigger.
  
  
  CONCLUSIONS
  About half of patients enrolled in a self-management technology intervention triggered at least one potential safety event over the course of the trial, and this was more frequent among some patients. Systems implementing HIT strategies to improve self-care and remote monitoring should consider specific program design elements to address these potential safety events.
authors.affiliation: Division of General Internal Medicine at San Francisco General Hospital, Center for Vulnerable Populations, University of California-San Francisco, CA 94110, USA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Andrea
authors.initials: A
authors.lastname: Lopez
authors.forename: Margaret
authors.initials: M
authors.lastname: Handley
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
mesh_terms: D048909:Diabetes Complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007003:Hypoglycemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods*; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone