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BACKGROUND/RATIONALE:
Diabetes patients' self-care plays a central role in determining the trajectory of their glycemic control and overall health, although patients frequently experience difficulty managing their complex self-care regimens. Many VA patients could benefit from more frequent follow-up with clinicians to support individual health monitoring and behavior change, but multiple barriers can prevent regular visits. To improve diabetes outcomes in VA, creative strategies are needed that can support self-management and prevent complications and costly acute health service use downstream. Informal caregivers (ICGs) may play a role in assisting veterans with diabetes to manage their diabetes self-care and maintain their health. Unfortunately, many ICGs have neither the requisite knowledge of diabetes management nor the ability to conduct frequent, systematic patient assessments to be effective in disease management support. Many individuals in patients' social network, in particular, adult children living outside the patient's home, may be willing to provide more help in supporting patients' self-care if a structure was in place to make that feasible.
OBJECTIVE(S):
The objectives of this pilot study are to: (1) work with DM-QUERI clinical consultants to develop diabetes-specific clinical content that can be incorporated into an informatics tool using automated telephone monitoring calls with feedback to ICGs in order to promote more effective self-care among veterans with diabetes; and (2) pilot test the intervention's feasibility and patients' satisfaction among a sample of diabetes patients and their ICGs receiving care at the Ann Arbor VA Medical Center (Ann Arbor VAMC).
METHODS:
This two phase project will involve content development and adaptation of a HF self-management support tool developed by the research team, followed by an evaluation of the diabetes self-management support service to obtain feedback from patients and their ICGs. We will work with a clinical consultation team to develop the assessment protocol with a focus on diabetes patients' health and self-care. A sample of patient-ICG pairs recruited through the Ann Arbor VAMC will use the automated monitoring and feedback service weekly for up to twelve weeks. A formative evaluation will be conducted to assess the feasibility of augmenting diabetes care with weekly, automated and behavior change calls to patients and feedback via the Internet to an out-of-home ICG. Baseline and follow-up patient and ICG surveys will measure general health, diabetes knowledge, depressive symptoms, patient-ICG relationship, and demographic characteristics. Follow-up surveys also assessed problems with using the system, patient and ICG satisfaction, and caregiving burden reported by ICGs. Development and refinement of the self-management service will occur from October - December, 2007; recruitment and data collection will be conducted from January - March, 2008.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Ties will be established with VA operations partners such as the Office of Care Coordination and MyHealtheVet, and plans will be developed for a broad-scale intervention study to assess the intervention's effectiveness for structuring assistance to ICGs in a manner that will promote a highly effective role in diabetes patients' overall disease management.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Quality of Care
Keywords:
Caregivers – not professionals
MeSH Terms:
none
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