SUPREME-DM (Diabetes Mellitis) Treatment Study

HealthPartners Institute

Status: Completed

Conditions: Diabetes

Treatments: Behavioral: Intervention Phone Call

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT02192255

10-018

Details and patient eligibility

About

This multisite pragmatic clinical trial was designed to assess the effectiveness of a single scripted telephone call to diabetes patients who (a) were currently above recommended clinical goals for glucose, blood pressure, or lipids, and (b) had recently been prescribed a new medication for that specific clinical domain. The goals of the intervention were to improve primary adherence and persistence to the newly prescribed medication and to improve control of glucose, blood pressure, and lipids.

Full description

This randomized trial tested the hypothesis that a telephone contact with a patient recently prescribed a new medication for uncontrolled glycated hemoglobin (A1c), blood pressure, or low-density lipoprotein cholesterol would improve (a) primary medication adherence, (b) medication persistence, (c) medication possession ratio, and (d) A1c, blood pressure or low-density lipoprotein cholesterol control. This study was part of the larger Agency for Healthcare Research and Quality funded SUPREME-DM study. The clinical trial reported here was coordinated and led by HealthPartners Institute for Education and Research, while data collection was coordinated through Kaiser Permanente Northwest and analysis was conducted at Kaiser Permanente Colorado. The clinical intervention sites for this study included Kaiser Permanente Northern California, Group Health Cooperative, Marshfield Clinic, and Geisinger Clinic.

Enrollment: 2,378 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• At each clinical intervention site, study subjects were selected if they:

  • were age 18-75 years
  • met study criteria for diabetes mellitus before study enrollment
  • received clinical care at a designated clinic or medical center involved in this study for at least 15 months before enrollment
  • were prescribed a new class of medication (not filled in the past 180 days) for A1c, BP, or LDL that was uncontrolled at the time of medication prescription (A1c>=8%, systolic BP>= 140 mm Hg, or LDL >=100 mg/dL).

Exclusion criteria

• Study subjects were excluded if they were younger than 18 years of age
• Older than 75 years of age
• Did not have evidence of diabetes mellitus prior to study enrollment
• Were not receiving care at a clinic site involved in this study for at least 15 months before enrollment
• Did not have prescribed a new class of medication for uncontrolled A1c, BP or LDL.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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2,378 participants in 2 patient groups

Intervention phone call

Experimental group

Description:

The intervention arm consisted of one protocol-structured telephone call from an interventionist who was a nurse health manager (1 site), diabetes educator or diabetes educator trainee (1 site), or pharmacist (2 sites). Interventionists followed the same structured telephone interview protocol to ascertain whether the subject had started taking the new prescription. Those taking the new medication as prescribed received positive reinforcement. Those who either had not filled the prescription or were not taking the medication as directed, were asked about reasons for nonadherence and assisted in identifying and resolving barriers. The median call lasted \< than 5 minutes, and up to 3 call attempts were made. Most intervention calls occurred within 2 to 6 weeks after the prescription date.

Treatment:

Behavioral: Intervention Phone Call

Control arm - usual care

No Intervention group

Description:

Those in the control arm received usual care.