There's no substitute for good communication when it comes to managing chronic health problems like heart failure, diabetes or asthma.
ANN ARBOR— For people who play a key role in the care of chronically ill friends or family members, targeted information provided on a systemized basis can help relieve the stress and burden of caregiving and improve outcomes for patients, research from the University of Michigan shows.
An increasing number of older adults who live with serious chronic health problems are unmarried and live alone. Even when spouses are present, husbands or wives often struggle with their own health challenges and competing demands on their time. As a result, people with chronic diseases such as heart failure often need support from family or friends who are not living under the same roof.
The U-M School of Public Health and Medical School, and the Ann Arbor Department of Veterans Affairs, collaborated on a trial to offer mobile health support for patients with heart failure and their informal caregivers. Their goal was twofold: to see if structured support from the program and informal caregivers could improve patients' self-care and health status, and to determine if systematized feedback to caregivers could alleviate their burden and help them avoid burnout and mental health concerns.
Investigators recruited 369 heart failure patients from the Veterans Health Care System and helped them identify an informal caregiver. Patients were placed in two groups. In one, patients received self-care monitoring and education via weekly automated calls with feedback about urgent health problems reported to their clinical team. In the other group, patients received identical services but with email feedback about their status and suggestions for how to help sent automatically to their family caregiver.
At six and 12 months into the trial, family caregivers in both groups were asked to complete assessments of caregiving strain, depressive symptoms and participation in self-care support. In the group where caregivers received feedback about their loved one, the caregivers reported less caregiver strain and depression than those in the comparison version of the program.
For caregivers with scores indicating clinically significant depressive symptoms at the time of enrollment, average scores remained below that threshold at both six and 12 months. Caregivers receiving feedback also reported more time spent with their patients including attendance at doctors' appointments (50 percent versus 40 percent), more involvement in patient medication adherence (43 percent versus 32 percent) and more time spent in supportive care (86 minutes per week versus 70 minutes).
Results on the intervention's impact on patient self-care behaviors and outcomes were reported separately earlier this year in the Journal of Medical Internet Research. In that article, the researchers found:
• Patients reported better medication adherence: 9 percent more at six months and nearly 14 percent more at 12 months for those in the mHealth+CP program.
• The also experienced fewer breathing problems: a 4 percent reduction at six months, 11 percent at 12 months.
• Patients experienced more stable weight: a 44 percent relative improvement when considering the expected rate of weight gain and when compared with the group that didn't have informal caregivers.
• Fewer patients in the trial group reported negative emotions during interactions with their caregivers.
• Other study authors were: Dana Striplin, Nicolle Marinec, Jenny Chen and James Aikens. Piette is affiliated with the Institute for Healthcare Policy and Innovation. (SOURCE: University of Michigan)
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