Integrating Support Persons into Diabetes Telemonitoring to Improve Self-Management and Medication Adherence

Aikens, James E.; Trivedi, Ranak; Aron, David C.; Piette, John D.

doi:10.1007/s11606-014-3101-9

Cited by 48 publications

(43 citation statements)

References 29 publications

(28 reference statements)

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“…Caregiver feedback has been associated with increased IVR engagement among patients with diabetes or depression 17,22 and may improve patients' health and self-care. [23][24][25] More generally, patients with an active and involved informal caregiver often have better self-management practices and health outcomes than patients who manage their chronic disease in isolation. [26][27][28][29] An observational study including Spanish-speaking patients from three countries suggests that caregiver feedback may increase patients' likelihood of completing IVR calls in LMICs.…”

Section: Barriers To Intervention Engagement and Scalingmentioning

confidence: 99%

“…These findings are consistent with results from U.S. studies, including nonrandomized studies of a similar intervention conducted with diabetes and depression patients and a recently completed randomized trial in which CarePartner feedback was associated with decreased problem reports among patients with heart failure. [23][24][25] To our knowledge, this is the first binational collaborative trial to provide evidence that feedback to informal caregivers may significantly improve LMIC patients' engagement in m-health interventions. However, one major limitation is that our reliance on self-reported outcomes could have biased the results.…”

mentioning

confidence: 95%

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Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Piette

Marinec

Janda

et al. 2016

Telemedicine and e-Health

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This trial is registered at ClinicalTrials.gov with clinical trial registration number HUM00081734. AbstractBackground: Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low-and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers (''CarePartners'') increased engagement in m-health support among diabetes and hypertension patients in Bolivia. Materials and Methods: Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone (''standard m-health'') or with automated feedback about health and selfcare needs sent to their CarePartner after each IVR call (''m-health+CP''). Results: The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had £6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard mhealth (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). Mhealth+CP patients were more likely to report excellent health

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Section: Barriers To Intervention Engagement and Scalingmentioning

confidence: 99%

mentioning

confidence: 95%

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Piette

Marinec

Janda

et al. 2016

Telemedicine and e-Health

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“…25,28,30,37,39,42,43,45,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] These comprised 79 research papers and 10 guidelines or discussion pieces. Other papers cited in this chapter are for background information and did not undergo full data extraction.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…The authors suggest that the mediating mechanisms were emotional support leading to improved ability to regulate one's own behaviour, direct assistance with diabetes problem-solving provided by the care partner, and reinforcement of adherence. 63 Despite this, family carers often feel undervalued or excluded from decision-making, and they may be ill-prepared to take on responsibility for SM. 39,42,64,79 The situation is often further complicated by the fact that they may take on SM-related tasks only once there is a crisis or a failure to adhere to medication.…”

Section: Programme Theorymentioning

confidence: 99%

Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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“…T his study conducted by Aikens et al 1 explored the potential benefits for medication adherence among diabetics after integrating a support person (relative or friend) into a VA-based telemonitoring program. These patients participated in 3-6 months of weekly telemonitoring via Interactive Voice Response Calls.…”

mentioning

confidence: 99%

Capsule Commentary on Aikens et al., Integrating Support Persons into Diabetes Telemonitoring to Improve Self-Management and Medication Adherence

Mohammad

2015

J GEN INTERN MED

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Integrating Support Persons into Diabetes Telemonitoring to Improve Self-Management and Medication Adherence

Cited by 48 publications

References 29 publications

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Managing diabetes in people with dementia: a realist review

Capsule Commentary on Aikens et al., Integrating Support Persons into Diabetes Telemonitoring to Improve Self-Management and Medication Adherence

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