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Published byMorris Wilkins Modified over 9 years ago
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Monika M. Safford, MD University of Alabama at Birmingham
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Pain is common in diabetes 60-80% persons with diabetes report chronic pain Osteoarthritis (OA) most common cause Pain is a barrier to self-care Cluster-randomized RCT, rural Alabama Participants: adults w. diabetes + chronic pain Intervention: ▪ CHW-delivered telephone + DVD ▪ Cognitive behavior training to maximize functioning despite pain ▪ Diabetes self –care ▪ CERs: OA, diabetes; integrated into education/training program content Outcomes: risk factors (A1c, BP, chol), functional status
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Reach Participation rates Representativeness among the sampling frame of patients with diabetes Strengths: Telephonic delivery Challenges: Community realities - “bring a neighbor” Denominators
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Reach HIGH
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Efficacy/Effectiveness Design: RCT Outcomes: ▪ Primary Metabolic control (A1c, BP, chol) Functional status ▪ Secondary Self-care behaviors Cost Strengths: Community setting – representativeness/effectiveness One-on-one, potent intervention DVD component Challenges: Community-member delivered – intervention fidelity
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Effectiveness MED-HIGH
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Adoption More speculative (!) Cost Requires new resources? Strengths: Low-cost Challenges: No infrastructure to sustain program (Healthcare Reform?)
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Adoption LOW (MED?)
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Implementation Low complexity: high Sustainable intervention fidelity: high Strengths: Cultural concordance lowers complexity Telephone Challenges: Community interventionists increase complexity Training needs Reliance on tenuous infrastructure (Healthcare Reform?)
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Implementation LOW (MED?)
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Maintenance Individual: ▪ What is f/u? ▪ Do social networks form? ▪ Is tailoring required? System: ▪ Does motivation for intervention reside in community-based organization? ▪ Outreach via telephone: low cost, flexible (reimbursement?)
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Maintenance Strengths: ▪ Social networks? ▪ Telephone delivery Challenges: ▪ No structure for sustained f/u (Healthcare Reform?) ▪ Motivation for intervention does not reside in community-based organization
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Maintenance MED
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REAIMAudience(s)Clinical Area(s) In Person CHW Outreach Acad. Detailing Med Low Med Patient Provider Diabetes Group CER Training School Group Therapy Med High Low Med Low Med Low Med Policy Patient Multiple Heart Disease Diabetes eHealth Clinic Kiosk Web Patient Portal Med Low Med High Med High Patient Patient & Provider Diabetes Print/Media Targeted VideoMed PatientHeart Disease
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REAIMAudience(s)Clinical Area(s) In Person CHW Outreach Acad. Detailing Med Low Med Patient Provider Diabetes Group CER Training School Group Therapy Med High Low Med Low Med Low Med Policy Patient Multiple Heart Disease Diabetes eHealth Clinic Kiosk Web Patient Portal Med Low Med High Med High Patient Patient & Provider Diabetes Print/Media Targeted VideoMed PatientHeart Disease
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REAIM In Person CHW Outreach CHW Telephonic Outreach Med High Med (High?) Low (Med?) Low Low (Med?) Low Med
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CER’s “Arm chair quarterbacking” Comparison framework e-VALUE-ation QALYs?
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