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2015 HSR&D/QUERI National Conference Abstract

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1129 — Improving Diabetes Management by Engaging Family Supporters in the Patient-Centered Medical Home: A Pilot Intervention

Rosland AM, VA Ann Arbor COIN; Heisler M, VA Ann Arbor COIN; Trivedi R, VA Palo Alto COIN; Gaudioso S, VA Ann Arbor COIN; Fennelly J, University of Michigan School of Pharmacy; Piette JD, VA Ann Arbor COIN;

Objectives:
Patient-Centered Medical Homes (PCMH) aim to provide diabetes patients with comprehensive support for following complex care regimens, however success relies on patient engagement in care. More than half 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 diabetes control.

Methods:
Veterans with diabetes with poor glycemic or blood pressure control participated with a Care Partner for 4 months. Patient-Care Partner dyads received coaching on health care engagement and evidence-based support skills, coaching to prepare for primary care visits, after-visit summaries, and automated phone calls to detect and share potential problems with diabetes management.

Results:
19 dyads were recruited among 77 patients screened. 18/19 patients were men (mean age 66 years). 11/19 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 more patients reported that Care Partners helped them track medications (29% to 63%, p = 0.04) and decide when to call their doctor/nurse with a 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). Patients bringing home-glucose logs to most medical visits increased (26% to 55%, p = 0.07), and Patient Engagement in Patient-Physician Interactions scale scores increased (8.9 to 9.3, p = 0.2). 95% of patients and 89% of Care Partners said they were satisfied with the program, and 84% of patients felt the program 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.

Implications:
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.

Impacts:
The impact of this intervention on patient engagement and diabetes complication risk factors will be further evaluated in a recently funded trial that will randomize 200 dyads to a 12-month version of the intervention vs. PCMH usual care.