Helping ‘Care Partners’ Help Patients with Diabetes

Sep 24, 2014, 9:00 AM

Ann-Marie Rosland, MD, MS, is a research scientist at the VA Ann Arbor Center for Clinical Management Research, an assistant professor at the University of Michigan Medical School, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2006-2009). She recently received a U.S. Department of Veterans Affairs Merit Award to test a family engagement intervention for patients with diabetes.

Human Capital Blog: Congratulations on your Veterans Health Administration (VA) Merit Award! The award recognizes your research into a family engagement intervention in the context of the VA’s patient-centered medical home program. How did your study work, and what did you find?

Ann-Marie Rosland: This study is unique in that we work with family member/patient pairs in managing diabetes. We call these family members “care partners.” This study asks the question:  “How we can best recognize and support the vital roles that patients’ family members often take in the care of chronic illnesses, so these care partners can have the largest positive impact on patients’ health and medical care?”

Our prior work has shown that the majority of people with diabetes, heart disease and other chronic conditions have a family member who is regularly involved with the care of these conditions. Some help to keep track of medications and refill them, some help to track and manage symptoms or sugar readings, many come to medical appointments and help patients communicate with their medical teams, and some help patients navigate the health care system. In general, patients who have support from family members tend to be more successful at managing chronic illness, particularly with eating healthier and exercising more. Yet patients and family tell us that care partners face barriers in helping with the medical side of care; for example, they can’t easily find out what medications or tests the patient’s medical team is recommending, or what health system programs are available to the patient.

In this intervention, called CO-IMPACT (Caring Others Increasing EngageMent in Patient Aligned Care Teams), we address these barriers by opening channels of communication between medical teams and care partners, so care partners can contribute questions and information to the patient’s primary care visit agenda and get information about the patient’s care plan after each primary care visit. We also give family members skills training and tools they can use to structure their conversations with patients about their chronic conditions to make them more helpful and effective.

Twenty patients with complicated diabetes and their care partners experienced CO-IMPACT in a pilot study and, overwhelmingly, patients felt it helped them improve their diabetes management. Care partners said they felt more confident they were giving helpful medical advice to patients, and focused much more attention on helping patients prepare for their medical appointments. We found a significant decrease in care partners’ distress about the patients’ diabetes. The VA Merit Award will fund a larger randomized controlled trial of the intervention to help determine what kind of impacts this type of program has on patients’ health and health care encounters.

HCB: What are the implications of your research for the VA’s medical home program, and for medical homes in general?

Rosland: Over the last few years, health researchers have learned more and more about how patient engagement in care is a key ingredient to successful health management. In particular, the VA’s patient-centered medical home program (called PACT, for Patient-Aligned Care Teams) offers patients a robust array of resources and programs to help them manage their chronic conditions. But to benefit from these resources, patients have to navigate the options and be engaged participants. Including patients’ family members in patient-centered medical home (PCMH) programs could be one way to boost patients’ ability to engage in PCMH care.

Also, the results of this research can help PCMH reach one of its key goals: to coordinate the entire team caring for the patient. For many patients, there is a family member who should be considered part of that team.  Medical home programs may find there are simple changes they can make to make family members feel welcome, informed and empowered, and to remove barriers to communication between family members and the health care team.

HCB: How does this study fit into your overall focus on mobilizing social, health care team, and community resources to help patients—especially underserved patients and veterans—manage chronic disease?

Rosland: People with complex chronic illnesses manage their conditions 365 days per year, but they will see a health care provider five or six times in a year. Engaging patients’ families is one of an array of approaches we might use to help patients with chronic conditions get the most out of their health care. Expanding the impact of health care will require coordinated efforts from teams of health care professionals, patients’ family and social networks, and programs in the patients’ communities. I hope to contribute to the work that many are pursuing to find ways to weave together this fabric of chronic disease management support, in ways that are practical and useful to patients and health care providers.

HCB: What are your next steps in this line of research?

Rosland: We designed CO-IMPACT to be implementable in existing PACT nursing encounters, using adaptations to existing VA patient communication tools. Through this larger study we hope to find which ways of coordinating and engaging patients’ family members are most effective at helping patients improve their health. Then we will work toward implementing those strategies throughout PACT for patients with diabetes and other chronic conditions.

HCB: You were an RWJF Clinical Scholar. Did the program prepare you for this work and, if so, how?

Rosland: Being an RWJF Clinical Scholar was a pivotal experience in my career. Through the amazing colleagues I met throughout the RWJF network, and the focus of that network on the wide range of influences on our health, I felt inspired and encouraged to explore how people’s family and community lives intersect with their experiences in the health care system, and how they might in the future ... and then there’s all the incredible training I received, skills I gained, and collaborators I met and continue to work with today. I’ve found that being a Clinical Scholar never really ends; I continue to be nourished by my relationships with my RWJF colleagues.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.