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Improving Diabetes Management by Engaging Family Supporters in the Patient-Centered Medical Home: A Pilot Intervention.

Rosland A, Heisler MM, Trivedi R, Gaudioso S, Fennelly J, Piette JD. Improving Diabetes Management by Engaging Family Supporters in the Patient-Centered Medical Home: A Pilot Intervention. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.


Abstract Text: Research Objective: Patient-Centered Medical Homes (PCMH) aim to provide diabetes patients with comprehensive, teambased support for following complex care regimens. Success, however, hinges on patients' ability to be actively engaged in care. While professional staff deliver most patient engagement interventions, 50-75% of adults with diabetes have a family member or friend (a "Care Partner") who regularly supports their diabetes management and could help them engage more effectively in care. This pilot study evaluated the feasibility and acceptability of an intervention to strengthen Care Partner capacity to help patients with high-risk diabetes engage in PCMH care and thereby improve their risk factor control. Study Design: Four-month intervention providing patient-Care Partner dyads with: one coaching session on health care engagement and evidence-based support skills; telephone coaching before patients' primary care visits; mailed after-visit summaries; weekly automated phone calls to prompt conversations about diabetes management; and tools to promote effective diabetes-related conversations. All components provided options for non-face-to-face Care Partner participation and could be delivered by PCMH team nurses. To assess feasibility and acceptability, we collected participant survey and medical record data at baseline and 4-month follow-up. Population Studied: Participants were recruited from a VA PCMH registry of diabetes patients at high risk for complications due to poor HbA1c or blood pressure (BP) control. Interested patients nominated a Care Partner. Principal Findings: 19 dyads were recruited among 77 patients screened. 18 patients were men (mean age 66 years). 11 Care Partners were co-habitating spouses. All 19 dyads completed the initial coaching session. 81% of attempted pre-visit preparation calls and 82% of attempted automated telephone assessments were completed. From baseline to follow-up the number of patients increased who reported that Care Partners helped them: track medications (29% to 63%, p = 0.04) and decide when to call their doctor/nurse with a diabetes-related problem (47% to 81%, p = 0.04). Care Partner self-efficacy in helping patients manage diabetes increased (8.0 to 8.6, p = 0.08). The number of patients bringing home-glucose logs to most medical visits increased from 26% to 55% (p = 0.07), and patients' engagement in clinician interactions increased from 8.9 to 9.3 (p = 0.2) on the Patient Engagement in Patient Physician Interactions scale. At follow-up, 95% of patients and 89% of Care Partners said they were satisfied with the program, and 84% of Submission Completed 1/15/15, 11:39 AM Page 2 of 4 both patients and Care Partners felt CO-IMPACT helped them more effectively manage diabetes. Care Partner Caregiver Strain Index scores decreased (1.6 to 1.1, p = 0.17). Patient and Care Partner-rated relationship quality did not change. Conclusions: An intervention that guides high-risk diabetes patients and their Care Partners through evidence-based patient engagement and support strategies is feasible and desirable to participants, with indications that the intervention may increase Care Partner support for patient engagement and patient engagement itself, and decrease Care Partner stress.

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