Nurse Telephone-Based Cardiovascular Disease Risk Management System

A Study from Finding Answers: Disparities Research for Change

Intervention title:
Nurse Telephone-Based Cardiovascular Disease Risk Management System, or, Cholesterol, Hypertension and Glucose Education (CHANGE)—Duke University Medical Center; Durham, N.C.

Goal:
To improve continuity of care, foster rapport between patient and health care system, and reduce cardiovascular disease (CVD) risk factors for African American patients.

Innovation:
Nurses from Duke University Medical Center called patients each month for a year to discuss the patients’ cardiovascular disease risk management. This provided an intensive supplement to the patients’ existing care that was completely integrated into the primary care delivery system. The conversations contained both standard and tailored components. The nurses’ discussions focused on teaching the dangers of poor cardiovascular disease control, presenting risk factors clearly and credibly, nurturing motivation to make positive changes in self-care, and helping patients progress through stages of positive behavior change. Nurses followed up with the patients’ primary care providers at regular intervals to provide patient updates and facilitate medication management.

Result:
Researchers conducted a randomized clinical trial in which 360 African American diabetes patients with hypertension and/or hyperlipidemia were randomized to either a control or an intervention group. Patients randomized to the control group received educational material about CVD reduction. Patients randomized to the intervention group received monthly follow-up calls from nurses as outlined above.

Preliminary data suggest improvements in adherence to medication regimens, A1c blood sugar levels, blood pressure and weight, with no increase in health care use for those in the intervention. The findings for improved blood pressure were negligible for the approximately 40 percent of the patient population that reported less than $10,000 in income per year, suggesting that for individuals with significant financial barriers, blood pressure control may be a substantial challenge.

Institution:
Duke University Medical Center
2301 Erwin Road
Durham, NC 27705-4699

From the experts:
“We didn’t want to be what some patients and clinics referred to as ‘seagulls.’ Seagulls come in, they peck and they leave. We brought the study results to Medicaid in North Carolina, and they are in the process of incorporating the project’s modules for hypertension into care for patients across the state. At the end of the day, we realized that it’s the content, putting it together, and targeting and personalizing it for individual patients, that makes this project unique. The telephonic intervention that we created for 400 patients will now be used with thousands of patients, reducing costs and improving people’s health.”

Hayden Bosworth, PhD
Research Professor, Duke University Medical Center
Principal Investigator

Profile:
Community-based primary care clinic

Clinical areas affected:

  • Outpatient clinics
  • Nurses
  • Primary care providers

Timeline:
The project began in April 2008 and lasted for more than two years. Researchers revised program materials and trained staff during most of the first year. The first participants received telephone-based care management starting in February 2009, with all calls completed by December 2010. Data collection and analysis continued into 2011.

Contact:
Hayden Bosworth, PhD
Principal Investigator
P: (919) 286-6936
boswo001@mc.duke.edu

Advice and lessons learned:

  1. Ensure that all the participants have the tools necessary to monitor their condition(s), such as glucose meters, strips and blood pressure monitors.
  2. Maintain monthly phone contacts using the same person. This allows the nurses to develop a rapport with the patients assigned to them even though they never meet face-to-face.
  3. Provide logbooks to patients to encourage active monitoring of their conditions.
  4. Provide patients with a cookbook that contains information about how to prepare healthy meals that have a low glycemic index.

Cost estimate:
Preliminary data suggest that the intervention improved blood sugar control and diabetes medication adherence, with no increase in health care utilization.

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