title: Integrating support persons into diabetes telemonitoring to improve self-management and medication adherence.
abstract: OBJECTIVE
  The purpose of this study was to investigate the potential benefits for medication adherence of integrating a patient-selected support person into an automated diabetes telemonitoring and self-management program, and to determine whether these benefits vary by patients' baseline level of psychological distress.
  
  
  METHODS
  The study was a quasi-experimental patient preference trial.
  
  
  METHODS
  The study included patients with type 2 diabetes who participated in three to six months of weekly automated telemonitoring via interactive voice response (IVR) calls, with the option of designating a supportive relative or friend to receive automated updates on the patient's health and self-management, along with guidance regarding potential patient assistance. We measured long-term medication adherence using the four-point Morisky Medication Adherence Scale (MMAS-4, possible range 0-4), weekly adherence with an IVR item, and psychological distress at baseline with the Mental Composite Summary (MCS) of the SF-12.
  
  
  RESULTS
  Of 98 initially nonadherent patients, 42% opted to involve a support person. Participants with a support person demonstrated significantly greater improvement in long-term adherence than those who participated alone (linear regression slopes: -1.17 vs. -0.57, respectively, p =0.001). Among distressed patients in particular, the odds of weekly nonadherence tended to decrease 25% per week for those with a support person (p =0.030), yet remained high for those who participated alone (p =0.820).
  
  
  CONCLUSIONS
  Despite their multiple challenges in illness self-management, patients with diabetes who are both nonadherent and psychologically distressed may benefit by the incorporation of a support person when they receive assistance via automated telemonitoring.
authors.affiliation: Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA, aikensj@umich.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
authors.forename: Ranak
authors.initials: R
authors.lastname: Trivedi
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D019468:Disease Management; D005260:Female; D057220:Health Literacy / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012648:Self Care / Q000379:methods* / Q000592:standards; D012944:Social Support; D017216:Telemedicine / Q000379:methods* / Q000592:standards