Social media advocates now have something to cheer about… sort of

[tweetmeme source=”Healthmessaging” only_single=false]Over the last year or two, lots of people have been jumping on the social media bandwagon, i.e., Twitter, Facebook, and so on. There has been a lot of talk about how social media and social networking will revolutionize health care…but little evidence to back this talk up.   Until now that is.
 
Before I get to the evidence that I referred to, I need to clarify something. The goal of social media as I understand it is to get people talking, sharing information and creating new ideas.   As applied to health care, one of the goals of social media is to get people/patients with like medical conditions taking, sharing and supporting one another.  Health care researchers refer to this phenomenon as peer support.   Peer support is not new to health care. Disease specific support groups (Breast Cancer, Diabetes, etc.) have been around for years. “Group” physician office visits comprised of patients with the same diagnosis have been around for years as well.
 
The Study
 
Now to the evidence. As anyone with a chronic condition or who treats patient with chronic conditions knows, patient self care is critical. Knowledge, skills and confidence are prerequisites for effective self care management.
 
A random controlled study recently published in the Annals of Internal Medicine looked at the efficacy of two alternative approaches helping patients with diabetes develop self care management efficacy:

• one-on-one telephone conversations between two patients (of similar age)with diabetes
• telephonic nurse care management

Male diabetes VA patients were randomly assigned to one of these two groups.  The HbA1c levels and blood pressures of patients assigned to both of the above intervention groups was measured at the start of the study and again at 6 months.  Patients in the peer support reviewed their test results, talked about care plans and received brief training in peer communication skills.  Peer partners were encouraged to call each other at least once a week.

Patients in the nurse care management group reviewed their test results, receive information about diabetes self care management and available care management services, and were encouraged to schedule follow-up telephone calls or face-to-face visits with that nurse care manager.

The Results

The study found that:

1. patients in the peer support intervention achieved HbA1c levels that were 0.58% lower on average than those of patients who received nurse care management.
2. patients in the RPS group with baseline HbA1c levels greater than 8.0% achieved a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group.
3. patients on insulin in the peer support intervention with HbA1c level >8% were more likely to have their treatment intensified.
4. patients in the peer support intervention reported a higher level of “diabetes-specific social support.”

These differences are both statistically and clinically significant.

Significance

The peer support intervention (like the nurse care management intervention) involved older males (average age of 62 years).  Older men are the last group I would have expected to pick up the phone and call another older male for information and support.  Presumably if peer support is well received by this group one can expect a broader adoption among other segments of the population.

The study provides hard evidence that peer support provided over the telephone can improve HbA1c levels among diabetic males.

The study presumes some level of knowledge and training in peer support communication skills among participants.

Take Aways

This study is one of the first randomly controlled studies to document the efficacy of a peer support intervention for a chronic condition.

This study did not look at web-based peer support. More research is needed to document efficacy of peer support delivered via the Internet, including e-mail and text.

Sources:

Heisler, et al.  Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management – A Randomized Trial. Annals of Internal Medicine. 2010;153:507-515.

Dale, J. et al.  Peer support telephone calls for improving health. The Cochrane Library. 2009, Issue 3.