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Analysis of the REMEDIES 4D clinical trial: a redesign of primary care to overcome clinical inertia and improve outcomes

Maloney, Maura (2016) Analysis of the REMEDIES 4D clinical trial: a redesign of primary care to overcome clinical inertia and improve outcomes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Approximately 29.1 million, or 9.3% of the total US population, currently have diabetes and this number is predicted to increase to 48.2 million by 2050. As the prevalence of diabetes increases, the number of complications associated with diabetes will likely increase as well. Diabetes associated complications can lead to dysfunction or failure of a number of organ systems such as the cardiovascular, cerebral, and renal systems. The key to reducing diabetes complications is to control the patient’s blood glucose, blood pressure, and cholesterol levels as well as providing preventative services. Fewer than 20% of people with diabetes have their blood glucose, blood pressure, and cholesterol levels adequately controlled. This is partly due to the failure to intensify diabetes treatments in a timely manner, also known as clinical inertia.
REdesigning MEDication Intensification Effectiveness Study for Diabetes (REMEDIES 4D) was a clinical study aimed at redesigning primary care to overcome this clinical inertia and improve patients’ diabetes outcomes. Certified Diabetes Educators (CDEs) implemented pre-approved, evidence based, medication intensification protocols for a yearlong intervention. These analyses show that the REMEDIES4D intervention improved patients’ blood glucose compared with the usual care group and those in the intervention were more likely to have their diabetes medication intensified; that clinician and medication satisfaction do impact medication adherence and clinical outcomes; and, for these participants, there were no correlations between two measures of cognitive performance with medication adherence and HbA1. This dissertation provided supporting evidence that CDEs in the primary care practice can improve patient’s outcomes and since CDEs focus on clinical and behavioral factors, they can better support patients’ behavioral and clinical goals. These findings are of public health significance since this model of care can be implemented in other community based primary care practices. In these practices, CDEs, a highly educated and underutilized resource, can work with primary care providers to better maintain people with diabetes clinical HbA1c goals, possibly reducing or delaying long term complications of diabetes and improving people with diabetes’ quality of life.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Maloney, Mauramam479@pitt.eduMAM479
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFabio,
Committee CoChairZgibor, Janice
Committee MemberNunley,
Committee MemberVan Panhuis, Willem
Committee MemberCostacou,
Date: 31 March 2016
Date Type: Submission
Defense Date: 25 April 2016
Approval Date: 29 June 2016
Submission Date: 5 May 2016
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 194
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: No
Uncontrolled Keywords: REMEDIES, Diabetes, T2D, Disseratation
Date Deposited: 29 Jun 2016 17:34
Last Modified: 01 May 2018 05:15


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