title: Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics.
abstract: BACKGROUND
  Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension.
  
  
  METHODS
  Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness.
  
  
  RESULTS
  Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending.
  
  
  CONCLUSIONS
  If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. matthew.crowley@dm.duke.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Crowley
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lindquist
authors.forename: Alice M
authors.initials: AM
authors.lastname: Neary
authors.forename: Amy C
authors.initials: AC
authors.lastname: Harris
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.forename: Bradi B
authors.initials: BB
authors.lastname: Granger
authors.forename: Katherine
authors.initials: K
authors.lastname: Pereira
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: David
authors.initials: D
authors.lastname: Edelman
mesh_terms: D001794:Blood Pressure; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D015444:Exercise; D006442:Glycated Hemoglobin; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D055118:Medication Adherence; D009726:Nurses; D010353:Patient Education as Topic / Q000379:methods*; D044469:Racial Groups; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D013689:Telephone
chemical_list: D006442:Glycated Hemoglobin
keywords: Behavioral Intervention; Case management; Diabetes; Hypertension; Self-management; Telemedicine
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