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Piette JD, Ann Arbor VA HSR&D Center Of Innovation; School of Public Health, University of Michigan; Department of Internal Medicine, University of Michigan; Striplin DT, Ann Arbor VA HSR&D Center Of Innovation; School of Public Health, University of Michigan; Marinec NA, Ann Arbor VA HSR&D Center Of Innovation; School of Public Health, University of Michigan; Chen J, Ann Arbor VA HSR&D Center Of Innovation; School of Public Health, University of Michigan; Aikens JE, Department of Family Medicine, University of Michigan;
Objectives:
The goal of this trial was to determine whether automated feedback to informal caregivers of Veterans with chronic heart failure (HF) decreases caregiving burden and increases engagement in self-management assistance.
Methods:
This was a randomized comparative effectiveness trial with a one-year follow-up. 372 Veterans with HF were recruited from outpatient clinics affiliated with the VA Cleveland Medical Center. All patients participated with a "CarePartner," or informal caregiver outside their household. Outcome data were available for 274 CarePartners. Patients randomized to "standard mHealth" received weekly automated telephone monitoring and self-care support calls for 12 months with notifications about medical concerns sent automatically to clinicians. "mHealth+CP" patients received identical services, with email summaries including suggestions for self-care assistance automatically sent to their CarePartners after each call. At baseline, 6 months, and 12 months, CarePartners completed assessments of caregiving stress, depressive symptoms, time involved in self-care support, participation in clinic visits, and assistance with medication adherence.
Results:
Among CarePartners with greater baseline caregiving stress, those randomized to mHealth+CP reported lower levels than those in the standard mHealth arm at both 6 and 12 months (p = .033 and .005, respectively). CarePartners with greater baseline depressive symptoms reported fewer symptoms at both endpoints in the mhealth+CP arm (both p < .008). Analyses of the intensity of caregiving involvement suggested that the intervention decreased the time required for caregivers to stay current about patients' self-care needs, while increasing involvement overall in self-management assistance. Compared to standard mHealth, mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (p = .046), and greater involvement in medication adherence at both endpoints (both p < .05).
Implications:
Feedback to informal caregivers of Veterans with HF decreases caregiving burden and increases engagement in self-care support.
Impacts:
These results support the broader evidence suggesting that mHealth updates and suggestions for informal caregivers outside the household of patients with chronic illnesses may improve patient outcomes, increase involvement in self-management support, and decrease caregiving burden. Given these positive findings, VA should seriously consider strategies for adopting this and similarly structured mHealth strategies that integrate informal caregivers into Veterans' self-management education and support.
