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IIR 95-118 – HSR&D Study

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IIR 95-118
Effectiveness of a Health Education Program in a Primary Care Setting
Joseph B. Engelhardt PhD
Albany VA Medical Center Samuel S. Stratton, Albany, NY
Albany, NY
Funding Period: October 1998 - March 2003

BACKGROUND/RATIONALE:
This study was designed to assess the effectiveness of a Health Education Program (HEP) for improving the well-being and reducing the health care use and cost of care of frail older outpatient veterans, and for improving the well-being of their spouse caregivers. HEP is a multi-component group program delivered in 8 weekly, 2-hour sessions, and 10 monthly 2-hour follow-up sessions, it includes emotion-focused and problem focused coping strategies, education and support.

OBJECTIVE(S):
The objectives of this study are to evaluate: 1) effects of HEP on the perceived health status, emotional well-being, and social support of frail veterans; 2) effects of HEP on the perceived health, emotional well-being, social support, burden levels, self-appraisal of change, pressing problems associated with caregiving, knowledge and use of community resources by caregiver; and 3) effects of HEP on the health care use and costs of care recipients.

METHODS:
HEP was evaluated using a randomized control group design. The design has two levels of intervention, HEP vs. Usual Care (UC), 3 VA medical centers (VAMCs), and 4 times of measurement (at baseline, after the 8th HEP meeting, and at 1 and 2 years after baseline). Data reported here are for 8 week and 1-year psychosocial outcomes and 18 months for VA cost. Caregivers and veterans (n = 466) were randomized in 3 VAMCs, 114 to UC and 119 to HEP. The typical caregiver was 68 years old, married, white, female, with some college education and living with the veteran. The typical veteran care recipient was 74 years old, white, male with some college education, and suffered from one or more chronic health problems. Fifteen HEP groups were conducted. Caregivers and recipients were assessed on: 1) health and functional status; 2) emotional well-being; and 3) social support. In addition, caregivers were assessed for change in coping skills, change in burden level, pressing problems, and knowledge and use of community resources. Data was analyzed using random effects regression models.

FINDINGS/RESULTS:
HEP was not effective in improving the perceived health status or emotional well-being of veterans. HEP had a positive effect on veterans for only 1 of 8 types of social support, reliable alliance. There was no significant difference between groups for total VA health care cost. For caregivers, HEP had significantly positive effects on: 1) subjective demand burden level; 2) stress of pressing problems associated with caregiving; 3) effectiveness managing pressing problems; 4) knowledge about aging, their spouses’ illness, and community resources; 5) thoughts, feelings, and actions in the caregiving situation; 6) improving the quality of the couples’ relationship; 7) increasing the extent to which caregivers took care of their own needs; 8) increasing perceived competence in caregiving; and 9) use of community resources. HEP did not, however, have any impact on caregiver perceived health status, emotional well-being, or social support. Audiotapes used for treatment integrity revealed caregivers found HEP helpful.

IMPACT:
Contrary to hypotheses, and the findings of a previous study, HEP had little impact on frail veterans at 1 year or health care costs at 18 months. HEP participation had many positive impacts on caregivers. It increased their use of community services, reduced the perceived demands of the caregiving situation, reduced the stress of problem behaviors and increased effectiveness in dealing with them, educated caregivers about aging and their spouses’ illness, helped caregivers to change they way they think, feel, and act in caregiving situations, and helped them to take better care of themselves.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care
DRE: Epidemiology, Treatment - Observational, Prevention
Keywords: Caregivers – not professionals, Education (patient), Frail elderly
MeSH Terms: Caregivers, Frail Elderly

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