Engaging Veterans and Family Supporters in PACT to Improve Diabetes Management

让退伍军人和家庭支持者参与 PACT 以改善糖尿病管理

• 批准号: 10165799
• 负责人: Ann-Marie Rosland
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165799
• 关键词: Address; Adult; Appointment; Behavior; Blood Glucose; Blood Pressure; Cardiac; Cardiovascular system; Caregiver Burden; Caregivers; Caring; Characteristics; Chronically Ill; Clinic; Clinical; Complex; Complications of Diabetes Mellitus; Diabetes Mellitus; Distress; Event; Family; Family Caregiver; Family member; Friends; Glucose; Glycosylated hemoglobin A; Goals; Health; Health behavior; Healthcare; Healthcare Systems; Healthy Eating; Home environment; Hyperglycemia; Hyperlipidemia; Hypertension; Hypoglycemia; Intervention; Knowledge; Life; Lipids; Measurement; Measures; Medical; Medical Records; Methods; Nurses; Outcome; Outcome Study; Participant; Patient Care; Patients; Play; Preparation; Primary Health Care; Process; Protocols documentation; Provider; Quality of Care; Randomized; Randomized Controlled Trials; Regimen; Reporting; Resources; Risk; Role; Self Efficacy; Self Management; Structure; System; Team Nursing; Techniques; Telephone; Testing; Treatment Protocols; Veterans; Visit; Work; base; blood pressure regulation; cardiovascular risk factor; care burden; design; diabetes distress; diabetes management; diabetes risk; diabetes self-management; evidence base; family support; glucose monitor; health literacy; health management; healthy lifestyle; high risk; improved; intervention effect; medical appointment; medication compliance; member; novel strategies; patient safety; prevent; primary outcome; public health relevance; randomized trial; recruit; satisfaction; secondary outcome; skills; success; tool

DESCRIPTION (provided by applicant): BACKGROUND: Veterans with diabetes must control cardiovascular risk factors in order to prevent disabling and life-threatening complications. However, despite system wide advances in diabetes quality of care, over 30% of VHA patients with diabetes continue to have uncontrolled blood pressure, hyperglycemia, or hyperlipidemia. The nationwide VA PACT (Patient-Aligned Care Teams) initiative seeks to provide VA primary care patients with comprehensive, team-based support for following diabetes care regimens. PACT's success, however, hinges on its ability to effectively engage patients in care. One relatively untapped resource for supporting engagement in PACT is patients' family and friends. Three out of four adults with diabetes reach out to an unpaid family member or friend (a 'health supporter') for ongoing help with diabetes management. These supporters help patients with medication adherence, tracking home glucose measurements, maintaining a healthy eating plan, and often accompany patients to their medical visits. However, while PACT emphasizes the importance of family members as part of the care team, PACT does not have formal mechanisms to involve health supporters in PACT care. Health supporters report that, in order to be more effective, they need more information on patient's medical care plans, clear channels for communicating with PACT team members, and information on navigating PACT resources. OBJECTIVES: The overall objective of this randomized trial is to test a strategy to strengthen the capacity of supporters to help patients with high-risk diabetes engage in PACT care and successfully enact care plans. The central hypothesis is that providing health care engagement tools to both health supporters and patients will increase patient activation and improve management of diabetes complication risks. METHODS: This will be a randomized controlled trial evaluating an intervention (Caring Others Increasing EngageMent in PACT, or CO-IMPACT) designed to structure and facilitate health supporter involvement in PACT so that patients can become more actively engaged in PACT care, and improve their diabetes treatment processes and outcomes. 220 patients with diabetes receiving PACT primary care who 1) are at high risk for diabetes complications due to hyperglycemia OR high blood pressure and 2) have a health supporter involved in their diabetes care will be recruited along with their health supporter. Patient-supporter dyads will be randomized to the CO-IMPACT intervention or usual PACT care for high-risk diabetes, for 12 months. The CO- IMPACT protocol provides patient-supporter dyads: one coaching session on action planning, communicating with providers, navigation skills and support skills; preparation by phone before patients' primary care visits; after-visit summaries by mail; and biweekly automated phone calls to prompt dyad action on new patient health concerns. CO-IMPACT builds on medical record-integrated patient activation tools in the PACT toolkit and is designed to be implementable within existing PACT nurse encounters. Primary outcomes for this study include a validated measure of patient activation (Patient Activation Measure-13) and a cardiac event 5-year risk score designed for patients with diabetes (UKPDS Risk Engine). Secondary outcomes include patients' self- efficacy for diabetes self-care; diabetes self-management behaviors including medication adherence; diabetes distress; and glycemic and blood pressure control. Measures among supporters will include supporter activation, use of effective support techniques, distress about patient's diabetes care, and caregiver burden. We will also measure patient-supporter and patient-provider relationship quality, patient safety (e.g. hypoglycemia), and utilization. We will measure potential moderators of intervention effect, such as patient health literacy level, and facilitators and barriers to wider implementation among participants and staff.

描述（由申请人提供）： 背景：患有糖尿病的退伍军人必须控制心血管危险因素，以防止致残和危及生命的并发症。然而，尽管糖尿病护理质量在系统范围内取得了进步，但超过30%的VHA糖尿病患者继续患有不受控制的血压、高血糖症或高脂血症。全国性的VA PACT（患者一致的护理团队）计划旨在为VA初级保健患者提供全面的，基于团队的支持，以遵循糖尿病护理方案。然而，PACT的成功取决于它有效地让病人参与护理的能力。支持参与PACT的一个相对未开发的资源是患者的家人和朋友。四分之三的糖尿病患者会向无报酬的家庭成员或朋友（“健康顾问”）寻求持续的糖尿病管理帮助。这些支持者帮助患者坚持服药，跟踪家庭血糖测量，保持健康的饮食计划，并经常陪同患者进行医疗访问。然而，虽然PACT强调家庭成员作为护理团队一部分的重要性，但PACT没有正式机制让保健支持者参与PACT护理。健康支持者报告说，为了更有效，他们需要更多关于患者医疗保健计划的信息，与PACT团队成员沟通的清晰渠道，以及关于导航PACT资源的信息。目标：这项随机试验的总体目标是测试一种策略，以加强支持者的能力，帮助高危糖尿病患者参与PACT护理并成功制定护理计划。中心假设是，为健康支持者和患者提供医疗保健参与工具将增加患者的激活并改善糖尿病并发症风险的管理。方法：这将是一项随机对照试验，评估一种干预措施（关爱他人增加参与PACT或CO-IMPACT），旨在构建和促进健康支持者参与PACT，使患者能够更积极地参与PACT护理，并改善其糖尿病治疗过程和结果。将招募220名接受PACT初级护理的糖尿病患者，这些患者1）由于高血糖症或高血压而具有糖尿病并发症的高风险，2）有健康支持者参与其糖尿病护理，沿着他们的健康支持者。患者-支持者配对将被随机分配至CO-IMPACT干预或常规PACT护理，治疗高危糖尿病，持续12个月。CO-IMPACT方案提供了患者-支持者二人组：关于行动计划、与提供者沟通、导航技能和支持技能的一次辅导课程;在患者初级保健就诊前通过电话进行准备;通过邮件进行就诊后总结;以及每两周一次的自动电话呼叫，以提示对新患者健康问题的二人组行动。CO-IMPACT建立在PACT工具包中的医疗记录集成患者激活工具的基础上，旨在在现有的PACT护士会面中实施。本研究的主要结局包括经验证的患者激活测量（患者激活测量-13）和为糖尿病患者设计的心脏事件5年风险评分（UKPDS风险引擎）。次要结局包括患者对糖尿病自我护理的自我效能;糖尿病自我管理行为，包括药物依从性;糖尿病痛苦;血糖和血压控制。支持者之间的措施将包括支持者的激活，使用有效的支持技术，对病人的糖尿病护理的困扰，和照顾者的负担。我们还将测量患者-支持者和患者-提供者关系质量、患者安全性（例如低血糖）和利用率。我们将衡量干预效果的潜在调节因素，如患者的健康素养水平，以及参与者和工作人员中更广泛实施的促进因素和障碍。