Intervention for Patient-Family Dyads Improves Outcomes for Veterans with Diabetes
BACKGROUND:
When adults with diabetes engage family and friends in their care, they have better outcomes. Thus, recent diabetes guidelines call for healthcare providers to include family supporters in diabetes care programs; however, healthcare teams are not equipped to effectively engage patient-family supporter pairs. To address this, researchers designed the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention to provide training and tools to adult patient-supporter dyads. This randomized clinical trial evaluated the CO-IMPACT intervention compared with standard care among Veterans with diabetes and HbA1c>8% or systolic blood pressure (SBP)>150mmHg, each with an adult supporter (239 dyads). Dyads were enrolled between 2016 and 2018, randomly assigned to the CO-IMPACT intervention or standard care, and followed for 15 months. CO-IMPACT dyads received a health coaching session focused on dyadic information sharing and positive support techniques, followed by 12 months of biweekly automated calls to prompt dyadic actions to meet diabetes goals, coaching calls to help dyads prepare for primary care visits, and after-visit summaries. Standard care dyads received general diabetes education materials only. The primary outcomes were 12-month changes in patient activation and diabetes-specific cardiac event risk scores. Secondary outcomes included 12-month changes in HbA1c, SBP, self-management behaviors, diabetes distress and self-efficacy, and satisfaction with health system support for family involvement.
FINDINGS:
- CO-IMPACT successfully engaged patient-supporter dyads and led to improved patient activation, diabetes self-efficacy, and healthy eating.
- Most (97% Veterans, 93% supporters) said they would “definitely” or “probably” recommend CO-IMPACT to others like them, and 83% of supporters felt they and the patient improved how they worked together to manage diabetes.
- Diabetes-specific cardiac risk and glycemic control improved similarly in both groups.
IMPLICATIONS:
- Engaging family supporters in a low-intensity coaching/monitoring program improved Veterans’ capacity to manage diabetes; a higher-intensity program may be necessary to improve outcomes.
LIMITATIONS:
- Veterans started the trial with high baseline activation and self-efficacy scores; patients with lower levels of activation and efficacy may experience different outcomes.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 14-074); Dr. Piette was supported by an HSR&D Research Career Scientist Award, and Dr. Trivedi by an HSR&D Career Development Award. Dr. Rosland is part of HSR&D’s Center for Health Equity Research and Promotion (CHERP); Drs. Piette and Heisler are part of HSR&D’s Center for Clinical Management Research (CCMR); and Dr. Trivedi is with HSR&D’s Center for Innovation to Implementation (Ci2i).
Rosland AM, Piette J, Trivedi R, et al, and Heisler M. Effectiveness of a Health Coaching Intervention for Patient-Family Dyads to Improve Outcomes among Adults with Diabetes: A Randomized Clinical Trial. JAMA Network Open. November 14, 2022;5(11):e2237960.
