An evaluation of Birmingham Own Health? telephone care management service among patients with poorly controlled diabetes. a retrospective comparison with the General Practice Research Database

摘要

Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health? is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change) for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. Methods Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health? (intervention cohort) and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD) to create a pool of 21,052 controls (control cohort). Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/-30 days limits) and within +/-90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. Results After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95%CI 0.1, 0.4%) in HbA1c; 3.5 mmHg (1.5, 5.5) in systolic blood pressure, 1.6 mmHg (0.4, 2.7) in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0) in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2)). More marked effects were seen for each clinical outcome among patients with worse baseline levels. Conclusions Despite the limitations of the study design, the results are consistent with the Birmingham Own Health? telephone care management intervention being effective in reducing HbA1c levels, blood pressure and BMI in people with diabetes, to a degree comparable with randomised controlled trials of similar interventions and clinically important. The effects appear to be greater in patients with poorer baseline levels and the intervention is effective in the most deprived populations.