V.V. Chirikov

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Background In this partially randomised intervention study, we assessed the effect of social networks on the improvement of type 2 diabetes management in a largely African–American population in Baltimore. Methods Patients in the intervention group (n=68) were asked to recruit peers, form small groups, and attend monthly diabetes education sessions, emphasising peer support. Patients in the control group (n=70) were recruited individually to attend standard diabetes education sessions. The primary outcomes were changes in haemoglobin A1C (HbA1c) and blood glucose. Secondary outcomes included blood pressure, weight, functional status, self-efficacy, perceived cohesion, social network connectedness and diabetes knowledge. General linear mixed models were built to assess mean absolute changes in primary and secondary outcomes at 3 and 6 months. Results At 6 months from baseline, the social network intervention group achieved a larger reduction in HbA1c of −0.32% (p<0.0001) and blood glucose of −10.6 mg/dL, (p<0.0001) compared to the control group. In analyses of secondary endpoints, the intervention group had more favourable outcomes over time for weight, quality of life, self-efficacy, social network scores and diabetes knowledge, compared to the control group. While blood pressure decreased, and perceived cohesion increased in both groups over the duration of the study, the difference between groups was not statistically significant. Conclusions The social networks intervention showed improved integration of patients within their existing networks leading to a greater reduction in HbA1c and blood glucose, as well as improved behaviour mediating outcomes.

Social Networks Help Control Hypertension

Cardiovascular health disparities continue to pose a major public health problem. The authors evaluated the effect of education administered within social networks on the improvement of hypertension in 248 African Americans compared with historical controls. Patients formed clusters with peers and attended monthly hypertension education sessions. The authors assessed the likelihood of reaching goal below predefined systolic blood pressure (SBP) and diastolic blood pressure (DBP) thresholds as well as the absolute reduction in SBP and DBP, controlling for diabetes, smoking, baseline hypertension, and demographics. The intervention group was more likely to have ever reached treatment goal at 12‐month follow‐up (odds ratio, 1.72; P=.11). At 18‐month follow‐up, the Maryland Cardiovascular Disease Promotion Program group had a statistically significant larger drop in SBP (−4.82 mm Hg, P<.0001) and DBP (−3.37 mm Hg, P=.01) than the control group. The clustering of patients in social networks around hypertension education has a positive impact on the management of hypertension in minority populations and may help address cardiovascular health disparities.

Transarterial Chemoembolization Treatment: Association between Multiple Treatments, Cumulative Expenditures, and Survival

OBJECTIVES To examine cumulative survival and Medicaid-paid expenses associated with multiple courses of transarterial chemoembolization (TACE) as primary treatment for hepatocellular carcinoma (HCC). METHODS Medicare enrollees diagnosed with primary HCC from 2000 to 2007, ever treated with TACE, but not transplant/resection, followed through 2009 by using the Surveillance, Epidemiology and End-Results Program and linked Medicare databases. Cumulative all-cause/HCC-related survival was estimated by using multivariate Cox proportional hazards models stratified by the total number of TACE treatments. Multivariate weighted Cox regressions estimated the average risk of mortality faced with nonproportional hazards. Lins inverse probability-weighted least squares regression method estimated cumulative Medicare expenditures adjusted for censoring and covariates. RESULTS Of 1228 patients, 34% were stage 1, 16% stage 2, 19% stage 3, 6% stage 4, and 26% unstaged. About 44% were aged 65 to 75 years, 69% were men, and 72% were Caucasian. Over half (57%) of the patients received one course, 24% two, 11% three, and 8% four courses of TACE. One-course patients incurred an average

Contextual analysis of determinants of late diagnosis of hepatitis C virus infection in Medicare patients

74,788 (95% confidence interval [CI]

Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program

71,890-

Dissemination and Adoption of the Advanced Primary Care Model in the Maryland Multi-Payer Patient Centered Medical Home Program

77,686), two-course patients

Impact of a comprehensive pharmacist medication-therapy management service

101,126 (95% CI

Physician specialty cost differences of treating nonmelanoma skin cancer.

94,395-

Real-world effectiveness of brentuximab vedotin versus physicians’ choice chemotherapy in patients with relapsed/refractory Hodgkin lymphoma following autologous stem cell transplantation in the United Kingdom and Germany

107,856), three-course patients

Research is needed on the difficult‐to‐cure population of HCV patients with disability

111,776 (95% CI