Please select the eligibility criteria that correspond to the clinical trial below.
Title: Patient and Provider Engagement and Empowerment Through Technology (P2E2T2) Program to Improve Health in Diabetes
Brief Summary: The overall goal of this proposal is to enhance the supports and resources available to patients with diabetes to assist them to achieve their health goals. The investigators will evaluate an innovative program that uses nurse health coaching, motivational interviewing techniques, wireless sensors and mobile health (mHealth) technology. In this program, patients will receive timely, tailored nurse coaching feedback to facilitate behavior change using mHealth technology, thus bridging bidirectional exchange of meaningful information among patient, nurse coach and provider. The investigators will conduct a randomized controlled trial among patients receiving chronic disease management at the University of California Davis(UC Davis) Primary Care Network. The patients who are eligible for inclusion in the study will be randomized to one of two arms of the trial: 1) Usual care (Care Coordination) administered by UC Davis Health Management and Education; or 2) the Patient and Provider Engagement and Empowerment through Technology (P2E2T2) Program to Improve Health in Diabetes. The hypothesis is that patients in the P2E2T2 arm of the study will be more engaged in identifying and achieving health goals related to their diabetes and will achieve better health outcomes compared to patients receiving usual care.


Options:
A: Inclusion Criteria:

* Admitted to a participating study hospital
* Diagnosis of acute coronary syndromes or heart failure

Exclusion Criteria:

* Too ill to participate
* Corrected visual acuity worse than 20/200
* Severe hearing impairment
* Patient is not being discharged to their home
* No regular telephone number
* Not fluent in English or Spanish
* Unintelligible speech
* In police custody
* Caregiver manages all medications
* Delirium or severe dementia
* Psychotic illness
* Already participating in a conflicting study
B: Inclusion Criteria:

* Age ≥ 55 years (from the day of the 55. birthday inclusive)
* Diagnosis of primary (essential) hypertension (I10 according to International Classification of Diseases (ICD-10))
* Filling of blood pressure-lowering prescription(s) at trial recruitment (Visit 1)
* Duration of antihypertensive drug treatment for at least 1 year without any discontinuation
* Ownership of a mobile phone for personal use with the ability to open and read SMS
* Understanding of Slovak language on native-speaker level
* Informed consent for participation in the clinical trial and personally signed Informed Consent Form

Exclusion Criteria:

Exclusion criteria assessed prior to patient enrolment (by trial pharmacists):

* Planned hospitalisation during the trial period (3 months)
* Biological impairment affecting the ability to read the SMS (e.g. loss of vision, visual field cuts, aphasia)
* Living in the same household with another trial participant
* Participation in another clinical trial

Exclusion criteria assessed after patient enrolment (by trial pharmacists and project leader):

* Hospitalisation during the trial period
* Patient informs he/she won't be able to participate in the trial
* Withdrawal of Informed Consent
C: Inclusion Criteria:

* 65 years or older taking 4 or more chronic medications independently living

Exclusion Criteria:

* assisted living or nursing home residents presence of any serious medical condition for which 1-year survival was expected to be unlikely
D: Inclusion Criteria:

1. At least 18 years of age
2. Diagnosis of Diabetes Mellitus (type 2)
3. Receiving care at one of the UC Davis Primary Care participating clinics (hospital-based Primary Care Clinic, the Folsom Primary Care Clinic)
4. Able to read, write, and speak English
5. Has access to a telephone and computing device
6. Has had experience with use of a mobile smartphone \& applications
7. HgbA1C over 6.5%

Exclusion Criteria:

1. Does not have Diabetes Mellitus
2. Primary language is not English
3. Pregnant women
4. Those that not have access to a telephone or computing device
5. Has a HgbA1C value under 6.5%

Answer: D