JMIR Publications

ABSTRACT

Background:

Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early, and addressing modifiable risk factors, is central to delaying renal complications such as diabetic kidney disease (DKD). Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support.

Objective:

This feasibility study aimed to: (1) build a population management program by identifying patients with diabetes and poorly controlled hypertension, who are at risk for adverse renal outcomes; and (2) evaluate a multi-factorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States.

Methods:

Patients were identified via electronic health record. Inclusion criteria were: age between 18 and 75 years; diagnosis of type 2 diabetes; poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg); access to a mobile telephone; and ability to receive text messages and emails. The intervention consisted of a monthly telephone call for 6 months by a case manager, and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed ≥ 4 calls were considered ‘engaged.’ The primary outcome was change in SBP at the conclusion of the intervention.

Results:

Of the 141 patients enrolled, 118 (84.0%, 118/141) patients completed ≥ 1 phone call and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (61.9%, 73/118), and non-white by self-report (87.3%, 103/118). The proportion of patients with poor SBP control at the start of the study was not significantly different from the proportion with poor SBP control at the end of the study. Given study engagement status (eg, completing ≥ 4 phone calls (98/118, 83%) or < 4 phone calls (20/118, 17%)), individuals with poor SBP control at baseline had a significantly larger decrease of 22 mmHg (95% CI 2.4, 41.6) in their SBP on average as compared to those individuals whose SBP was in control at baseline.

Conclusions:

This study is among the first to examine the use of mHealth supported with phone calls from case managers in a predominately minority and low-income sample from a FQHC. We successfully recruited and engaged patients with diabetes and poorly controlled hypertension into a multifactorial behavioral-educational intervention. The findings from this study indicate that population health applications can be easily applied with a potentiaNCT02418091lly promising impact on improving hypertension control. Clinical Trial: NCT02418091