VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA.
Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh Medical School, Pittsburgh, PA, USA.
J Gen Intern Med. 2022 Mar;37(4):761-768. doi: 10.1007/s11606-021-06946-8. Epub 2021 Jul 8.
Family support for adults' diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.
Assess the impact of a patient-supporter diabetes management intervention on supporters' engagement in patients' diabetes care, support techniques, and caregiving experience.
Multivariate regression models examined between-group differences in support-related measures observed as part of a larger trial randomizing participants to a dyadic intervention versus usual care.
A total of 239 adults with type 2 diabetes and either A1c >8% or systolic blood pressure >160mmHg enrolled with a family supporter.
Health coaches provided training on positive support techniques and facilitated self-management information sharing and goal-setting.
Patient and supporter reports at baseline and 12 months of supporter roles in diabetes care and caregiving experience.
At 12 months, intervention-assigned patients had higher odds of reporting increased supporter involvement in remembering medical appointments (AOR 2.74, 95% CI 1.44, 5.21), performing home testing (AOR 2.40, 95% CI 1.29, 4.46), accessing online portals (AOR 2.34, 95% CI 1.29, 4.30), deciding when to contact healthcare providers (AOR 2.12, 95% CI 1.15, 3.91), and refilling medications (AOR 2.10, 95% CI 1.14, 3.89), but not with attending medical appointments or with healthy eating and exercise. Intervention-assigned patients reported increased supporter use of autonomy supportive communication (+0.27 points on a 7-point scale, p=0.02) and goal-setting techniques (+0.30 points on a 5-point scale, p=0.01). There were no differences at 12 months in change scores measuring supporter distress about patients' diabetes or caregiving burden. Intervention-assigned supporters had significantly larger increases in satisfaction with health system support for their role (+0.88 points on a 10-point scale, p=0.01).
A dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress.
家庭对成年人糖尿病护理的支持与改善自我管理和结果有关，但医疗保健提供者缺乏让这些支持者参与的结构化方法。
评估患者-支持者糖尿病管理干预对支持者参与患者糖尿病护理、支持技术和护理体验的影响。
多变量回归模型分析了作为更大规模试验的一部分，参与者被随机分配到二元干预组与常规护理组之间，在支持相关措施方面的组间差异。
共有 239 名患有 2 型糖尿病的成年人，其糖化血红蛋白（A1c）>8%或收缩压>160mmHg，他们与一名家庭支持者一起参与研究。
健康教练提供了关于积极支持技术的培训，并促进了自我管理信息的共享和目标设定。
患者和支持者在基线和 12 个月时报告支持者在糖尿病护理和护理体验中的角色。
在 12 个月时，干预组分配的患者报告其支持者更多地参与记忆医疗预约（优势比[OR]2.74，95%置信区间[CI]1.44-5.21）、进行家庭测试（OR 2.40，95%CI 1.29-4.46）、访问在线门户（OR 2.34，95%CI 1.29-4.30）、决定何时联系医疗保健提供者（OR 2.12，95%CI 1.15-3.91）和（OR 2.10，95%CI 1.14-3.89）），但没有更多地参与医疗预约或健康饮食和运动。干预组分配的患者报告其支持者更多地使用自主支持性沟通（7 分制上增加 0.27 分，p=0.02）和目标设定技术（5 分制上增加 0.30 分，p=0.01）。在衡量患者糖尿病或护理负担相关的支持者困扰变化评分方面，12 个月时没有差异。干预组分配的支持者对其角色的健康系统支持满意度显著增加（10 分制上增加 0.88 分，p=0.01）。
二元患者-支持者干预措施导致家庭支持者更多地参与糖尿病自我管理，并增加了积极支持技术的使用，而不会增加护理人员的压力。
