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question:Despite system-wide advances in diabetes quality of care, over 30% of patients with diabetes treated in Veterans Health Administration health centers continue to have poorly controlled blood pressure, hyperglycemia, or hyperlipidemia. The nationwide VA PACT (Patient-Aligned Care Team) initiative seeks to provide these patients with comprehensive, team-based support for following diabetes care regimens. One relatively untapped resource for supporting engagement in PACT is patients’ family and friends. Three out of four adults with diabetes reach out to an unpaid family member or friend (a ‘CarePartner’) for ongoing help with diabetes management. These CarePartners help patients with medication adherence, tracking home glucose measurements, maintaining a healthy eating plan, and often accompany patients to their medical visits. CarePartners report that, in order to be more effective, they need more information on patient’s medical care plans, clear channels for communicating with PACT team members, and information on navigating PACT resources. In this randomized trial led by Ann-Marie Rosland, MD, MS, investigators are evaluating an intervention designed to activate dyads of CarePartners and veterans with diabetes. Two hundred forty patients receiving PACT primary care who are at high risk for diabetes complications will be recruited along with their CarePartner. Patient-supporter dyads will be randomized to the Caring Others Increasing EngageMent in PACT (CO-IMPACT) intervention or usual PACT care for 12 months. The CO-IMPACT intervention provides dyads with coaching for action planning, communicating with providers, navigation and support skills training, preparation by phone before patients’ primary care visits, after-visit summaries, and biweekly automated phone calls to prompt dyad action on new patient health concerns. The project builds on CMCD’s expertise in supporting diabetes patients and their family caregivers through mobile health tools. For more information, contact Shelley Stoll at [email protected]. How does the nationwide VA PACT initiative seek to provide comprehensive, team-based support for patients with diabetes?

answer:The nationwide VA PACT (Patient-Aligned Care Team) initiative seeks to provide patients with diabetes comprehensive, team-based support for following diabetes care regimens.

question:Can you provide more details about the CO-IMPACT intervention and how it specifically involves CarePartners?

answer:The CO-IMPACT intervention is designed to activate dyads of CarePartners and veterans with diabetes. The intervention provides coaching for action planning, communicating with providers, navigation and support skills training, preparation by phone before patients’ primary care visits, after-visit summaries, and biweekly automated phone calls to prompt dyad action on new patient health concerns. In other words, CarePartners are trained and provided with resources to help support veterans with diabetes in managing their care, including communicating with healthcare providers and navigating healthcare resources. The intervention aims to increase engagement of both the patient and their CarePartner in PACT care and improve patient outcomes.

question:Can you provide more information on how the CO-IMPACT intervention builds on CMCD's expertise in supporting diabetes patients and their family caregivers through mobile health tools?

answer:The CO-IMPACT intervention builds on the Center for Managing Chronic Diseases (CMCD)'s expertise in supporting diabetes patients and their family caregivers through mobile health tools by incorporating various tools and resources into the intervention. For example, the biweekly automated phone calls prompt dyads to take action on new patient health concerns, and after-visit summaries help to ensure that the CarePartner is fully informed about the patient's care plan. Additionally, the coaching and skills training provided to CarePartners are designed to help them navigate and effectively use mobile health tools and other resources that may be available to them. The goal is to empower CarePartners and provide them with the knowledge and skills necessary to support veterans with diabetes in managing their care using a combination of in-person and mobile health tools.

question:Can you please provide me with more information on how patients and their CarePartners are recruited for this randomized trial?

answer:In this randomized trial, patients receiving PACT primary care who are at high risk for diabetes complications will be recruited along with their CarePartner. Patients are identified through electronic health records using criteria such as having poorly controlled blood pressure, hyperglycemia, or hyperlipidemia. Patients who meet the eligibility criteria are contacted by phone to discuss the study, and if they are interested in participating, they provide names and contact information for their CarePartner. CarePartners are also contacted by phone to obtain their consent and confirm their willingness to participate in the study. After both patient and CarePartner have provided consent, they are randomized to either the CO-IMPACT intervention or usual PACT care for 12 months.