Duke University Medical Center
Durham, North Carolina
Diabetes and Cardiovascular Disease Risk Factors
African American

Project

Patients received monthly calls from nurses to discuss their disease risk management.

In this study, nurses call patients each month for a year to discuss the patients’ cardiovascular disease risk management. The conversations contain both standard and tailored components. The nurses’ discussions focus on teaching the dangers of poor cardiovascular disease control, presenting risk factors clearly and credibly, and enforcing the saliency of the hazard. At each call, topics for discussion are chosen based on an assessment of the patient’s knowledge and stage of behavior change. Nurses then contact providers at three, six, and nine months to provide patient updates and to facilitate medication management. All nurses receive training in community health, cultural sensitivity and motivational interviewing. The intervention takes place in community based primary care clinics affiliated with an academic medical center.

Rationale

Patients’ inability to achieve accepted targets of chronic disease control likely arises from a complex interaction of treatment non-adherence and providers’ lack of treatment intensification (clinical inertia). This intervention targets both patients and providers and addresses multiple chronic conditions contributing to cardiovascular disease risk.

A multi-behavior, comprehensive approach is proposed because no one factor has been shown to consistently improve cardiovascular disease outcomes. The intervention is tailored to the needs of vulnerable, high-risk patients and uses existing clinical infrastructure, including nurses. It builds rapport between patients and nurses, which has the potential to improve continuity of care. More frequent contact with patients allows physicians to make decisions about changing medications, ordering additional tests or scheduling additional clinic appointments depending on the patient’s situation.

Summary Results

African American patients received monthly, individually tailored calls from nurses to discuss cardiovascular disease risk management. The intervention significantly increased patient self-reported medication adherence by 22% (vs 2% increase in control), and significantly decreased HbA1c values by 0.25 absolute percentage points (vs 0.04 percentage point increase in control).

Publications

The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: Study design and methodology
American Heart Journal. 2009. 158(3): 342-348
Full Article (subscription may be required)

The Cholesterol, Hypertension, and Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes
American Heart Journal. 2013.
Full Article (subscription may be required)

Story from the Field

• With extra support from their nursing staff, the physicians at Duke Family Medical Center have successfully empowered their Black patients to take control of their health.

Principal Investigators

• Hayden B. Bosworth, PhD (Research Professor, Duke University Medical Center)
• Benjamin Powers, MD (Assistant Professor, Duke University Medical Center)