Abstract

Background: The diabetes epidemic call for integrative solutions to address this challenge. 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 led by a personal nurse and MTC's multi-disciplinary staff is based on the chronic care model (CCM) empowering patients to self-management through self-efficacy. Aim: To examine the association between MTC's treatment setting (CCM + telemedicine) and patients’ DM self-efficacy (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, and HbA1c > 8%. Patients who were recruited to MTC comprised the intervention group. Patients matched by demographic and clinical variables encompassed the control group. During the 8-9 month intervention period MTC personal nurse proactively contacts the patient and develops a personalized care plan including clinical targets. The personal nurse monitors the patient's condition, provides guidance and empowers him/her to self-management. Patients in the control group received standard community care. All participants completed DMSE Scale at baseline, 3-4 months and 8-9 months. Data regarding compliance index and HbA1c values were drawn from patient's medical record. 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 index increased in the intervention group and declined in the control group (p < .05). Hb1Ac values declined in both the intervention (-2.11%) and the control (-1.41%) groups though the decline was greater in the intervention group (p < .001). Conclusions: This study demonstrates the effect of MTC plan led by nurse on creating a cognitive-behavioral-clinical change among diabetes patients. Tailored interventions are effective in increasing self-efficacy and achieving selfmanagement.