Effectiveness of reminders in increasing compliance to SBGM - Essay Example

?Research Proposal: Effectiveness of reminders in increasing compliance to SBGM Introduction According to the World Health Organization (WHO, , there are about 346 million people in the world suffering from diabetes. In 2004, 3.4 million deaths were attributed to this disease and more than 80% of these deaths came from the low and middle income families. The WHO (2011) also estimates that the rates of diabetes deaths will double from 2005 to 2030 with increasing rates seen with each year. Diabetes is a chronic disease which becomes apparent with the pancreas not producing enough insulin and when the body cannot adequately use the insulin that it produces (WHO, 2011). Insulin is a hormone which functions to manage and regulate blood sugar. High blood sugar is often seen with uncontrolled diabetes and persistently high levels often lead to serious damage of the body’s organs, including the nerves and blood vessels (WHO, 2011). Various interventions have been made available in order to control and manage blood sugar levels and the impact of diabetes. Self-monitoring of blood glucose (SMBG) has been made one of the essential therapies for this disease, mostly in order to allow immediate monitoring of blood glucose levels and to prevent steep increases and decreases of blood sugar levels (Benjamin, 2012). This paper shall discuss SMBG, specifically the effect of self-reminders on the compliance with the SMBG process. 2. Literature review Various studies have been carried out on the impact of self reminders and the use of SMBG in the monitoring of diabetes. In a paper by Karter, et.al., (2001), the authors sought to assess the impact of self-monitoring blood glucose levels in improving blood sugar levels. Their study was carried out as a cohort design which was applied in order to detect the relation between self-monitoring frequency and the first glycosylated hemoglobin level in 1997. There were about 24,000 diabetic patients included in the study. The authors were able to establish clear results which indicated that the use of self-monitoring blood glucose tests was also associated with lower HbA1c levels. All in all, the study revealed that with more frequent SMBG processes applied, it was possible to achieve lower glucose levels and therefore better outcomes for patients with diabetes (Karter, et.al., 2001). In yet another study by Karter and colleagues (2000), the authors set out to establish the various barriers in the application of SMBG. Their study was a cross-sectional study which sought to evaluate SMBG use and its barriers in about 44,000 diabetic patients who were being treated in the Kaiser Permanente Northern California Region. The authors were able to establish that 60% of type 1 diabetic patients and 67% type 2 diabetic patients indicated a lesser frequency in their SMBG. Most of the reasons for their failure to carry out their SMBG included the following: longer time since diagnosis, male sex, age, ethnic minority, lower education, lower income, non-English speaking, high cost of glucometer strips, smoking, and excessive smoking. In effect, the authors were able to highlight that there were significant gaps in the actual and recommended SMBG practices in the organization covered with the dominant elements relating to ethnicity and language barriers being strong determinants of SMBG compliance. Moreover, low income also seems to impact the use of SMBG with the affordability of these strips put to issue (Karter, et.al., 2000). Despite studies proving that patients’ improved blood glucose levels with SMBG, various studies reveal that there is a lack of compliance with home blood glucose monitoring. Burge (2001) discusses that about 67% of patients with diabetes fail to routinely evaluate their blood glucose and they have various reasons for such failure. These reasons include: pain and soreness, wide variation in the recommended frequency of blood sugar monitoring, and the perception that home SMBG is less recommended in their care. The study by Burge (2001) sought to study current home blood glucose monitoring practices about this activity from 1999 to 2000. The study revealed better compliance with increased duration of diabetes; but compliance also decreased when doctor’s visits decreased or when hospitalizations decreased. In effect, with higher monitoring from patients, with their doctors or with hospitals, improved rates in blood glucose were apparent (Burge, 2000). This study was however limited because it was not randomized and was determined through self-evaluation. It also recommended the need for clear guidelines for monitoring to be established during each visit; and for strategies in improving compliance recommended for the patients. Lastly, these remedies must be recommended in order to improve the role and understanding of SMBG in reducing blood glucose levels (Burge, 2000). Graham (2005) considered, in a similar vein, SMBG for intensive diabetes management. In general, the study was able to establish that SMBG is beneficial for the patient because, as mentioned in previous studies, it would help the patients understand their disease and the importance of monitoring their blood glucose levels. SMBG also provides reminders for them, especially when follow-up checkups with their doctor have to be made, and when it is advisable for them to manage their food intake (Graham, 2005). Knowing their blood glucose levels helps them avoid the extremes of their disease – too much blood sugar or too low. Under these conditions, the complications of their disease may be avoided. Graham (2005) was also able to establish the issues or barriers in the compliance with SMBG. These issues include: cost, forgetfulness, lack of health education on their disease, and that this process is too bothersome and the patients are satisfied with their medications. Due to the above concerns, Delameter (2006) discusses that adherence issues are apparent among diabetic patients. The compliance with the regimen is dynamic and multidimensional; and adhering to one aspect may not necessarily be related to adherence in other areas. Nevertheless, it is important to understand why non-adherence sometimes occurs for some patients. Factors often seen in failure of compliance with any regimen include elements such as: demographic, psychological, social, health care provider, and medical system as well as disease and treatment-related elements (Delameter, 2006). In a study by Meier, et.al., (2002) carried out their research in order to establish the impact of a modification of guidelines on SMBG on the levels of Hemoglobin A1c and of the cost of the managing the disease. Their study was a retrospective clinical trial where the authors instructed the patients with type 2 diabetes to carry out SMBG based on the guidelines of the Veterans Affairs. The level of hemoglobin A1c and the cost of the monitoring was then evaluated in the process of research (Meier, et.al., 2002). With research processes in place, the authors evaluated baseline levels of blood sugar. In the course of the study, the patients were given about two strips a day for their SMBG. The post-implementation HbA1c levels were then measured. After testing, the authors were able to establish reliable and coherent results, with results strongly supporting the results from previously conducted studies (Meier, et.al., 2002). With a higher frequency in SMBG, diabetic patients were most likely to experience lower blood sugar levels. This meant better savings for the patients, we well as improved outcomes. Peel, et.al., (2004) acknowledged in their study that the use of SMBG is controversial and costly. Moreover, they also point out that there is some doubt of whether or not self-monitoring actually improved blood glucose control. Their study therefore, sought to evaluate the advantages and disadvantages of glucose monitoring based on the patient’s perspective. Since the study is being considered from the patient’s perspective, the researchers carried out their study as a qualitative repeat-interview with 40 patients recruited from three hospital clinics and four local health cooperatives in Lothian Scotland (Peel, et.al., 2004). After the interviews were consolidated, it was established that the process of glucose monitoring itself can increase the awareness of patients regarding diabetes, as well as issues which relate to diet. The patients also mention that the SMBG process helped establish a sense of success or failure about self-monitoring, thereby either adding to or reducing their anxiety levels regarding their disease (Peel, et.al., 2004). Overall, the authors established that SMBG was a welcome addition to diabetes management for patients because it helped the patients understand their disease and the importance of managing and monitoring their blood glucose levels. The approach of researchers Liang, et.al., (2011) was geared towards evaluating the impact of mobile phone interventions in blood sugar control in the self-management of diabetes. Their study was a meta-analysis, searching through various applicable databases for relevant and related studies. Their review was able to come up with 22 applicable trials, covering 1657 participants in mobile phone interventions in self-monitoring of blood glucose levels (Liang, et.al., 2011). After analysis, the authors were able to come up with 11 studies which manifested a significant decrease in their blood glucose levels after mobile interventions were carried out in their self-monitoring process. All in all, pooled results from studies provided strong evidence for the value of mobile interventions in the control of blood glucose levels and in the self-management of diabetes. In the systematic review by Krishna and Boren (2008), the authors set out to evaluate diabetes self-management care through cell phones. The authors covered the Medline database from 1966 to 2007, extracting relevant data for their review. About 20 articles met the inclusion criteria with outcomes and assessments measured in terms of learning, behavior change, clinical improvement, and improved health status. Reported changes in blood glucose levels were also determined. The review established that with cell phone and text messages, patient-provider and parent-child communication and satisfaction with care was apparent (Krishna and Bowen, 2008). In effect, the study established that clinical improvements were apparent with better knowledge and self-sufficiency. Therefore, there is a need to facilitate regular treatment in the advice and support in between clinic visits (Krishna and Bowen, 2008). A good tool is therefore needed in order to alert the patient and issue reminders and avoiding diabetic symptomatology can be gained with timely reminders and therefore lead to better patient outcomes. In a similar vein, Hanauer (2009) acknowledges the fact that cell phone text messaging through SMS provides opportunities for a convenient and inexpensive means of engaging young adults in the management of their diabetes. Hanauer (2009) sought to compare two-way SMS cell phone messaging and email reminders in ensuring SMBG. About 40 type 1 diabetic adolescents and young adults were included in this study and were randomly assigned to receive either text messages or email reminders for the SMBG. The study revealed that those who received SMS, as compared to those receiving emails had higher rates of compliance with their cell phone text messaging. All in all, based on this study and previous studies cited, reminders in SMBG are favorable options for improving compliance with SMBG and in managing blood glucose levels. Using SMS or text messages are especially advantageous for patients and is more effective in improving compliance and in reducing blood glucose levels. 3. Research aims/ Research questions The purpose of the research is to explore the effectiveness of reminders in increasing compliance to SBGM. It seeks to answer the following questions: a. Does SMBG reduce the blood glucose levels before and after monitoring? b. What are the barriers to the compliance of SMBG? c. Do text reminders or mobile reminders assist in complying with SMBG? d. Which type of reminder is preferred by patients? e. Which type of reminder was able to effectively improve SMBG? 4. Methodology This study shall be carried out as a quasi-experimental study, seeking to evaluate the cause and effect relationship between the different variables based on controlled conditions (Burns and Grove, 2005). The target population will be 150 diabetes patients in about five SingHealth polyclinics. It will span two weeks with a clinic attendance database used to identify the respondents. The inclusion criteria would be diabetic patients over 21 years of age with handphones (or with caregivers having handphones) available. The patient or caregiver must have finished at least primary school education. Patients to be excluded shall be those with a significant co-morbidity; and those who verbalize their discomfort or incompetence in carrying out SBGM. The reminders shall be given to patients via phone of SMS twice a day, before and after lunch. The control group will be instructed to stay under treatment and the intervention group would attend about 50 minutes of consultation with an RN to review data on self-monitoring, including special package on glucometers. The respondents’ informed consent shall be sought, explaining all the pertinent details of the research, including the risks and the processes which would be involved in the conduct of the study. The respondents’ confidentiality shall be assured and maintained at all times and respondents would be assured that all data gathered would be for statistical purposes only. Their names shall not appear on any data sheet and in the final reports. All data shall not be made available for any other purpose other than the current research project. The participation of the respondents would remain voluntary at all times with respondents allowed to withdraw at any time. 5. Data Analysis Data will be tabulated, collated, and entered in the SPSS program for specific analysis. The mean, range, standard variation will be used in order to computable patterns for the data gathered. The chi-square and T-test will be used to process the data to analyzable figures. Descriptive statistics shall be carried out in order to establish the profile of the respondents, including their occupation, age, gender, race, education levels, as well as more relevant data on SBGM rates, rates preference on phone service and SMS service, and reminder response rates. The SBGM baseline rates will be gathered for all the respondents and preference reminders will also be ascertained for the different patients. The SBGM adherence rate after reminder will also be determined. The SBGM Nurse survey will be used in order to establish the preferences and use for each nurse; a pre and post research survey will also be used in order to evaluate the patient’s preferences in their self-monitoring process. 6. Evaluation In evaluating the data above for this proposal, the measure criteria shall include the SBGM rate itself, as well as their patient’s preference on reminders and the rate of SBGM adherence after the reminders are given. The recommendation of service to the diabetic patient shall also be considered with appropriate basis and standards revealed in this study. The findings of this study can be considered contributory towards diabetes patient education, widespread use of SBGM processes, training of diabetic nurses, and increased funding for the SBGM program. 7. Conclusion Based on the details presented above, this proposal serves to evaluate whether or not giving reminders to students help reduce blood glucose levels. This study will be carried out with the end goal of promoting self monitoring for patients and for a more active role in reducing their blood glucose levels. The reminder system is a system meant to improve compliance with SBGM and will also serve to make the patients more responsible in their personal care. References Benjamin, E. (2012). Self-Monitoring of Blood Glucose: The Basics. Clinical Diabetes, 2(1), pp. 45-47. Burge, M.R. (2001). Lack of compliance with home blood glucose monitoring predicts hospitalization in Diabetes. Retrieved from http://care.diabetesjournals.org/content/24/8/1502.long. Delamater, A.M. (2006). Improving patient adherence. Clinical Diabetes, 24(2), 71-77. Graham, R. (2005). Self-Monitoring of Blood Glucose (SMBG): Considerations for Intensive Diabetes Management. Journal for Managed Care and Hospital Formulary Management, 30(12),1-28. Hanauer, D.A., Wentzell K., Laffel N., & Laffel LM. (2009). Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management. Diabetes Technology & Therapeutics, 11(2), 99-106. Karter, A., Ackerson, L., Darbinian, J., D’Agostino, R. et.al., (2001). Self-monitoring of Blood Glucose Levels and Glycemic Control: the Northern California Kaiser Permanente Diabetes Registry. Retrieved from http://cgsmedicare.com/jc/MDCorner/PDF/Karter_AJM_2001.pdf Karter, A.J, Ferrara, A.,  Darbinia, J.A., Ackerson, L.M., & Selby, J.V., (2000). Self-Monitoring of Blood Glucose: Language and financial barriers in a managed care population with diabetes. DIABETES CARE, 23 (4). Krishna, S., & Boren, S.A. (2008). Diabetes self-management care via cell phone: A systematic review. Journal of Diabetes Science and Technology, 2(3), 509-517. Liang, X., Wang, Q., Yang, X., Cao, J., Chen, J., Mo, X., Huang, J., Wang, L., & Gu, D. (2011). Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabetic Medicine, 28(4), 455-463, doi: 10.1111/j.1464-5491.2010.03180.x Meier, J., Swislocki, A., Lopez, J., Noth, R., Bartlebaugh, P., & Siegel, D. (2002). Reduction in Self-Monitoring of Blood Glucose in Persons with Type 2 Diabetes Results in Cost Savings and No Change in Glycemic Control. Am J Manag Care, 8, 557-565. Peel, E., Parry, O., Douglas, M., & Lawton, J. (2004). Blood glucose self-monitoring in non- insulin-treated type 2 patients. British journal of general practice, 183. World Health Organization (2011). Diabetes. Retrieved 26 March 2012 from http://www.who.int/mediacentre/factsheets/fs312/en/index.html Read More