Development of telephone supportive self care model and evaluation of its impacts on glycemic control and self care among type II diabetic patients in Bangkok metropolitan

Abstract

The objectives of this research were to develop the diabetes telephone supportive self-care model for self-management support, and to evaluate its impacts on glycemic control and diabetes self-management among type 2 diabetic patients. The author developed the automated telephone system with diabetes knowledge inside the interactive voice response subsystem to provide diversified curriculum arrangement including general knowledge modules, suggestive segment modules, and 10 question and answer (QA) sets for assessment with tailored information. The evaluation of 3 month effect was conducted by the randomized controlled trial on enrollees, 224 diabetes type 2 patients of diabetic clinics of King Chulalongkorn Memorial Hospital and Ladkrabang Hospital. The intervention arm received automated diabetes education calls two times a week for 5 weeks and followed by once a week for 7 weeks, with educator follow -up calls The pooled results of unadjusted analysis showed that HbA1c level of the intervention group lowered significantly than usual care group,-0.42 % (p<0.001; 95% CI, -1.03 to -0.28). Using multiple regression analysis, adjusted age, HbA1 c baseline level, and medical service settings, the magnitude of intervention effect on HbA1c reduction is -0.38 % (95% CI, -0.73 to -0.02). Sub setting analysis showed different effect between the two health service settings. The effect is very strong at a primary and secondary care, Ladkrabang Hospital (-0.78% of HbA1c; 95% CI, -1.24 to -0.32). No self-management behavior changes show significant difference within groups, but change scores of self-efficacy and quality of life were significantly higher in the intervention group (p<0.001). The acceptability to the program was also examined among 112 participants in the intervention group. Most study participants reported that they were satisfied with the program and regarded its usefulness and helpfulness on awareness, understanding, and reminding behavior change attempts. Eighty one point two (81.2) percent of the respondents reported to participate in the next program This prototype of diabetes telephone-linked care for Thai diabetes is a step forward in response to diabetes self-care management and education need. Further studies need more investigations including effective long-distance education tools, long-term efficacy of diabetes self-care improvement, script improvement for targeted groups, as well as its cost effectiveness.