ABSTRACT
We evaluated a disease management and education programme delivered via telephone support (TS) to patients with poorly controlled diabetes (HbA1c >7%). All eligible patients were invited to participate in the programme, which involved education on lifestyle modification and disease management delivered via three scheduled monthly calls by trained nurses. Patients who declined or could not be contacted acted as the controls (usual care, UC). A per protocol analysis was conducted using a mixed effect model for two subgroups with different baseline HbA1c levels (i.e. baseline HbA1c <8.0% and HbA1c ≥8.0%). A total of 2646 patients with diabetes were eligible for enrolment. Of these, 1391 participants had HbA1c measurements available. The study comprised 633 patients (46%) who completed the programme (TS), 598 (43%) who were not contactable or refused to participate at the first telephone call (UC) and 160 patients who dropped out. In the patients with HbA1c ≥8%, TS reduced the adjusted mean HbA1c by 0.38% (P = 0.022) but the reduction in diabetes-related admissions (4.2% lower adjusted mean admission rate) was not significant. In patients with HbA1c <8%, TS had no additional effect on glycaemic control or diabetes-related admission. Telephone support appeared effective in improving glycaemic control in patients with poor diabetes control.
Subject(s)
Diabetes Mellitus/therapy , Telemedicine/methods , Adult , Aged , Case-Control Studies , Diabetes Mellitus/blood , Disease Management , Female , Glycated Hemoglobin/analysis , Hospitalization/statistics & numerical data , Humans , Life Style , Male , Middle Aged , Patient Education as Topic/methods , Singapore , TelephoneABSTRACT
The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
