• Ilta Lange, Solange Campos, Mila Urrutia, Claudia Bustamante, Claudia Alcayaga, Alvaro Tellez, J Carola Pérez, Luis Villarroel, Gaston Chamorro, Annette O'Connor, and John Piette.
• Escuela de Enfermería, Centro Colaborador en Atencón Primaria OMS-OPS, Facultad de Medicina, Pontificia Universidad Cató1ica de Chile, Santiago de Chile. ilange@uc.cl
• Rev Med Chil. 2010 Jun 1; 138 (6): 729737729-37.

BackgroundTelephone based self-management support may improve the metabolic control of patients with type2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing.AimTo assess the efficacy of a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile.Material And MethodsTwo primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the "Summary of Diabetes Self-care Activities Measure" and the "Spanish Diabetes Self-efficacy" scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated.ResultsThe IG maintained its HbA1c level (baseline and final levels of 8.3 +/- 2.3% and 8.5 +/- 2.2% respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 +/- 2.3 and 8.8 +/- 2.3% respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased.ConclusionsThe ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

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