Effectiveness of a Case Management Model for Patients With Hypertension and Type II Diabetes in Chile

Study Overview
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Brief Summary
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The purpose of this study is to evaluate whether a new model of health care for chronic patients, based on Case Management and guided by a nurse which targets the patient´s risk, is more effective than usual care at Primary Health care in Chile. Additionally, this intervention would provide a better quality of care and a more efficient health provision.

Official Title
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Evaluation of a Model of Care for People With Hypertension and Type II Diabetes Based on Case Management and Risk Adjustment

Conditions
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Hypertension, Diabetes Mellitus, Type 2

Intervention / Treatment
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* Other: Case Management
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults diagnosed with Hypertension and/ or Type 2 Diabetes Exclusion Criteria: Severe mental illness and / or deterioration of cognitive abilities. Severe hearing loss. Diagnosed with cancer Stage 4 or 5 of chronic kidney disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 82 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Case Management<br> | Other: Case Management<br>* A model of health care for chronic patients, based on Case Management and guided by a nurse which targets the patient´s risk. The core elements of this strategy are: a. processes to identify specific population and their risk; b. evidence-based practice guidelines according to risk (higher risk, more interventions and monitoring by a nurse, lower risk, higher emphasis on self-care); c. Practice models based on collaboration between health team members leaded by a nurse; d. self-management education for patients; e. monitoring patients face to face or by telephone to ensure to follow the care program (blood test, medical consultation, for example); e. measurement of process and outcomes.<br>|
| Active Comparator: Control<br>Usual Care at Primary Health Care | Other: Usual Care<br>* Usual Care at Primary Health Care Center<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glycated Hemoglobin |  | One year | 
| Systolic and Diastolic Blood Pressure |  | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Care | Measured by Clinical records audits | one year | 
| Patient satisfaction | Measured by a questionnaire | one year | 
| Medication adherence | Measured by Morisky- Green questionnaire | one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hypertension, Diabetes Mellitus, Type 2, Case Management