Enhancing Informal Caregiving to Support Diabetes Self-Management

加强非正式护理以支持糖尿病自我管理

• 批准号: 8105971
• 负责人: James E Aikens
• 金额: $ 45.93万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-05 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8105971
• 关键词: Abbreviations; Address; Adult; American; Biological; Blood Pressure; Caregiver Burden; Caregivers; Caring; Child; Chronic; Chronic Disease; Chronically Ill; Communities; Comorbidity; Complications of Diabetes Mellitus; Congestive; Congestive Heart Failure; Data; Diabetes Mellitus; Diabetic Angiopathies; Distress; Effectiveness; Electronic Mail; Ensure; Family member; Financial cost; Friends; Funding; Glycosylated hemoglobin A; Guidelines; Health; Health Benefit; Health Status; Heart; Heart failure; Helping Behavior; Home environment; Human Resources; Hypotension; Intervention; Life; Link; Low income; Mediating; Mediation; Mediator of activation protein; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patients; Play; Problem behavior; Public Health; Randomized; Recruitment Activity; Regimen; Reporting; Resources; Risk; Self Management; Services; Specific qualifier value; Structure; System; Technology; Telephone; Time; Training; Underinsured; Update; Work; base; burnout; care giving burden; caregiving; clinical research site; cost; design; diabetes control; experience; geographically distant; glycemic control; health related quality of life; improved; interpersonal conflict; meetings; multidisciplinary; prevent; primary outcome; programs; psychosocial; secondary outcome; social

DESCRIPTION (provided by applicant): Although in-home caregivers (ICGs) help improve diabetes mellitus (DM) outcomes, they may lack the resources needed to do this optimally, and are at risk for psychosocial decline and "caregiver burnout." Complicating matters, millions of chronically-ill older Americans live alone and receive "long-distance caregiving" without any supporting structure or resources to ensure its effectiveness. Preliminary data indicate that DM patients will engage in automated telemonitoring consistently for sustained periods. The resulting data seems to validly detect changes over time in health status and self-management. We propose to link patients with a non-household family member or close friend (the "CarePartner;" CP) who is willing to support the patient's health and self-management in close coordination with the patient's ICG (if one exists) and clinician(s). Through automated telemonitoring, patients will provide weekly updates on their DM health and self-management. Summaries of this will be emailed to CPs along with guidance on helping the patient address reported problem(s); clinicians will be alerted about medically-urgent problems. We found a similar intervention to be feasible and potentially effective in another challenging setting, i.e., congestive heart failure self-management. For this proposal, we developed DM-related telephone scripts and detailed participant guidelines. In this resubmission, we now include pilot data that not only indicates that DM patients are very receptive to the intervention, but also addresses a Reviewer concerns by suggesting that the intervention is unlikely to create or worsen interpersonal conflicts between CPs, ICGs, and patients. We now propose a community-based effectiveness RCT. Specific Aim 1 is to compare the effects of CP intervention to telemonitoring alone (control) upon 12-month glycemic control and DM-related distress for patients with poorly-controlled DM (i.e., initial HbA1c > 8.0%). Specific Aim 2 is to examine secondary effects on DM self-management, health-related quality of life, systolic blood pressure, caregiver burden, relationship quality, and cost of DM care. We have already recruited clinical sites serving large numbers of low-income and underinsured patients, whom this intervention was especially designed to benefit. If this intervention proves effective without increasing costs or clinician burden, then its implementation could yield major public health benefits, especially for vulnerable and underserved DM patients. Broader societal benefit may occur through increased helping behavior and strengthened social ties. Followup work could adapt the intervention for use with comorbid conditions and other chronic conditions requiring self-management. PUBLIC HEALTH RELEVANCE: Although many older Americans with diabetes receive caregiving assistance from someone they live with, this situation often leads to caregiver stress and burnout. Many other diabetes patients live by themselves, but could use this type of assistance to remain healthy and avoid complications. This project addresses both problems by linking diabetes patients with someone from outside their home who they already know well, and training this "CarePartner" to help the patient achieve good diabetes control. If successful, this program could prevent diabetes complications for many thousands of older Americans who would otherwise be socially isolated and medically under-served.

描述（由申请人提供）：尽管家庭护理人员（ICG）有助于改善糖尿病（DM）结果，但他们可能缺乏最佳做到这一点所需的资源，并且有可能出现社会心理衰落和“照顾者倦怠”的风险。使事情变得复杂，成千上万的长期持续的美国人独自生活并获得“长途照顾”，而没有任何支持结构或资源以确保其有效性。初步数据表明，DM患者将在持续时间内持续进行自动远程监控。最终的数据似乎可以在健康状况和自我管理中有效地检测到随着时间的变化。我们建议将患者与非家庭家庭成员或密友（“ Carepartner; CP）联系起来，他们愿意与患者的健康和自我管理与患者的ICG（如果存在）和临床医生密切协调。通过自动远程监控，患者将每周提供有关其DM健康和自我管理的更新。此摘要将通过电子邮件发送给CPS，并提供有关帮助患者地址报告的问题的指南；临床医生将被告知医学上紧急的问题。我们发现类似的干预措施是可行的，并且在另一个具有挑战性的环境中，即充血性心力衰竭自我管理也有效。对于此建议，我们制定了与DM相关的电话脚本和详细的参与者指南。在此重新提交中，我们现在包括了试点数据，这些数据不仅表明DM患者非常接受干预，而且还通过暗示干预措施不太可能引起或恶化CPS，ICGS和患者之间的人际关系冲突来解决审查者的担忧。现在，我们提出基于社区的有效性RCT。具体目的1是比较CP干预对单独的远程监控（对照）对12个月血糖控制和与DM相关的困扰的影响对控制不良的DM患者（即初始HBA1C> 8.0％）。具体目标2是检查对DM自我管理，与健康相关的生活质量，收缩压，护理人员负担，关系质量和DM护理成本的次要影响。我们已经招募了为大量低收入和保险不足的患者提供服务的临床部位，这些干预措施旨在受益。如果这种干预措施在没有增加成本或临床医生负担的情况下有效，那么其实施可能会带来重大的公共卫生益处，尤其是对于脆弱和服务不足的DM患者。通过增加帮助行为和加强社会联系可能会发生更广泛的社会利益。后续工作可以调整干预措施，以在合并症条件和其他需要自我管理的慢性条件下使用。 公共卫生相关性：尽管许多患有糖尿病的老年人会从与之同住的人那里获得照顾帮助，但这种情况通常会导致护理人员的压力和倦怠。许多其他糖尿病患者自己生活，但可以使用这种援助来保持健康并避免并发症。该项目通过将糖尿病患者与他们家外面的人联系起来，解决了这两个问题，他们已经知道了，并培训了这种“摄取者”，以帮助患者获得良好的糖尿病控制。如果成功的话，该计划可以防止成千上万的年龄较大的美国人糖尿病并发症，否则他们将在社会上孤立并且服务不足。