Maccabi HealthCare Services | Israel
Title: Change in DM self-efficacy for self management –MTC effect compared to standard community care
Biography: Angela Irony
Background: The diabetes epidemic call for integrative solutions to address this challenge. Designated interventions are needed in order to prevent or delay diabetes complications. Maccabi Telecare Center (MTC) is a multi-disciplinary service providing a remote treatment solution to 6,000 members who suffer from chronic illness. Proactive monitoring by MTC's multi-disciplinary staff is based on the chronic care model (CCM) empowering patients to self-management through selfefficacy.
Aim: To examine the association between MTC's treatment setting (CCM + telemedicine) and patients’ DM selfefficacy (DMSE) and other health outcomes compared with the DMSE of patients receiving standard community care.
Method: A large-scale comparative prospective study with stratified sampling and repeat measures. Study population include all HMO members with diabetes type 2, with HbA1c > 8%. Patients who were recruited to MTC comprised the intervension group. Patients matched by demographic and clinical variables composed the control group. In the 8-9 month intervention period patients were trained and empowered in self-management. Patients in the control group received standard community care. At baseline, all participants completed DMSE Scale; IPQ-R (illness representation); PHQ (depression) and SF-12 (Qol) at baseline, 3-4 months and 8-9 months. Results: 832 patients - 433 (intervention) and 399 (control) – aged 59 (±11.3) , 8.9 (±5.5) years of diabetes duration and HbA1c of 10.1 at baseline (±1.7). Participation in the intervention group was related to higher DMSE along the study period. At baseline, DMSE in both groups was identical (p = NS), yet after 3-4 months and after 8-9 months DMSE was higher in the intervention group (p < .001). Second, over the study period, compliance increased in the intervention group and declined in the control group (p < .05). Hb1Ac values declined in both groups although the decline was greater in the intervention group (p < .001). No differences were found in QoL and depression levels between the study groups. Illness representation affected patients’ QoL and mood, independent of study group. Conclusions: This study demonstrates MTC
impact on creating a cognitive-behavioral-clinical change among diabetes patients. Thus, a short-term intervention designed to achieve change in self-management is sufficient to improve health-related measures and delay diabetes complications.