High-Touch Intervention Yields Success for Patients with Diabetes, Hypertension

(PRNewswire) — A new health behavior intervention has been spelling success for North Carolina patients with diabetes and hypertension. The intervention, Cholesterol, Hypertension and Glucose Education, or CHANGE, was piloted in a study led by principal investigator Hayden Bosworth, PhD, at Duke University Medical Center, and rolled out this spring to patients enrolled in the Northern Piedmont Community Care system. The demonstrated success of the program is leading to an expected expansion of the intervention to all North Carolina Medicaid practices in the coming months.

In the CHANGE intervention, patients recommended by their primary care physicians are called on a monthly basis by nurses who discuss management of their chronic conditions with them. The nurses guide patients through discussion modules on topics ranging from weight, diet and exercise, to medications, side effects, memory, depression, stress, patient-provider interactions and social support. Some topics are discussed at every call, while some are dependent on a patient’s needs–a unique model that allows the intervention to be both responsive and flexible.

Regular contact with a real person makes a difference. “We talk with the same patient every month and over time develop real relationships with them,” explains CHANGE nurse Pamela Gentry. “They begin to anticipate our calls, writing down questions to ask us. We revisit topics and reinforce what is important, are able to nip problems in the bud, and encourage lifestyle changes that will have a positive impact on their overall health. When someone else answers the phone and says, ‘it’s your nurse,’ we know the patient (and their family) sees a real relationship with us.”

The CHANGE study was focused on African American patients and was developed in response to the significant racial disparities in mortality in relation to cardiovascular disease (CVD). “CVD and diabetes account for over one-third of the mortality difference between African American and white patients,” points out Bosworth. “The increased risk for African Americans is due to the fact that Black patients are twice as likely to have more than three CVD risk factors as white patients. CHANGE was designed with this imbalance in mind, and is aimed at improving CVD outcomes in African American adults with diabetes by addressing modifiable risk factors such as systolic blood pressure and LDL cholesterol.”

CHANGE nurses are trained in motivational interviewing techniques and make quarterly reports on patients’ progress and medication issues to primary care providers. The CHANGE study, conducted in 2009, enrolled 360 high-risk African American patients with chronic diabetes and hypertension, who had had at least one primary care visit at a participating clinic in the preceding year. Half of the patients received educational materials, and half received monthly telephone calls from a nurse for twelve months, in addition to the educational materials. The CHANGE study has had encouraging results, showing positive changes in patients’ adherence to medication regimens, A1C blood sugar levels, blood pressure and weight.


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