Abstract
BackgroundMost adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”). These family supporters are an important resource who could be leveraged to improve patients’ engagement in their care and patient health outcomes. However, healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient self-management support. This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications.Methods/designWe will conduct a randomized trial evaluating the CO-IMPACT (Caring Others Increasing EnageMent in Patient Aligned Care Teams) intervention. Two hunded forty adults with diabetes who are at high risk for diabetes complications due to poor glycemic control or high blood pressure will be randomized, along with a family supporter (living either with the patient or remotely), to CO-IMPACT or enhanced usual primary care for 12 months. CO-IMPACT provides patient-supporter dyads: it provides one coaching session addressing supporter techniques for helping patients with behavior change motivation, action planning, and proactive communication with healthcare providers; biweekly automated phone calls to prompt dyad action on new patient health concerns; phone calls to prompt preparation for patients’ primary care visits; and primary care visit summaries sent to both patient and supporter. Primary outcomes are changes in patient activation, as measured by the Patient Activation Measure-13, and change in 5-year cardiac event risk, as measured by the United Kingdom Prospective Diabetes Study cardiac risk score for people with diabetes. Secondary outcomes include patients’ diabetes self-management behaviors, diabetes distress, and glycemic and blood pressure control. Measures among supporters will include use of effective support techniques, burden, and distress about patient’s diabetes care.DiscussionIf effective in improving patient activation and diabetes management, CO-IMPACT will provide healthcare teams with evidence-based tools and techniques to engage patients’ available family or friends in supporting patient self-management, even if they live remotely. The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities.Trial registrationClinicalTrials.gov, NCT02328326. Registered on 31 December 2014.
Highlights
Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”)
The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities
We hypothesize that COIMPACT will significantly increase patient activation, as measured by the Patient Activation Measure-13 (PAM-13) compared to usual Veterans Affairs (VA) Patient Aligned Care Teams (PACT) care
Summary
Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”). Healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient selfmanagement support This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications. These “high-risk” patients are given treatment regimens that are complicated and often difficult to follow in day-to-day life These patients must effectively communicate and coordinate with multiple medical providers and proficiently navigate the healthcare system. In light of these complex care needs, high-risk patients often need more support than the healthcare systems have the capacity to offer
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