A promising approach to enhancing chronic illness self-management support is to increase mutual support among patients facing similar health and behavioral challenges.
While group therapy is one mechanism for bringing patients together to discuss their common problems and identify strategies for meeting self-care goals, many patients face barriers to attending frequent clinic or group visits.
Service Innovation: Interactive Voice Response System
QUICCC investigators are developing a multifaceted intervention that combines group self-management training with peer-to-peer telephone support using a specialized, interactive voice response system.
The IVR calling system is designed to enhance the effectiveness of the group visit model by enhancing patients’ contact with a ‘peer support partner’ throughout their daily lives.
The IVR calling system allows patients to:
1. Call their peer support partner without charge.
2. Enter a peer relationship without the need to share their home phone number or other identifying information.
3. Have all patient-to-patient calls blocked if requested.
4. Designate times outside of which calls from their partner are blocked.
5. Send and receive live and recorded telephone messages with a care manager when questions or problems require clinical guidance.
In pilot studies, QUICCC investigators found that this calling system was easy for patients with diabetes and patients with heart failure to use and that it facilitated peer support.
Ongoing research and development
With funding from the National VA Health Services Research and Development Program, o QUICCC investigators are conducting a randomized trial evaluating the impact of peer support calls plus group visits on diabetes patients’ self-management behaviors, glycemic controls and service use. QUICCC investigators have also received National Institutes of Health funding to conduct a translational research study of this specialized peer-support service among patients with heart failure who are receiving care within the St. Joseph Mercy Health System.
In two related pilot projects, QUICCC investigators are expaind the peer-support service so that it can be made available to patients with other serious chronic conditions. In one study, investigators are testing a peer-support service designed for patients with chronic depression. In a second study, investigators are partnering with the National Kidney Foundation of Michigan to develop and pilot test a peer support service for patients with advanced kidney disease.
A growing number of older, chronically-ill patients need frequent self-management support, while health care systems are experiencing growing strains on their limited resources.Patients’ informal care networks, which include family and friends living at a distance, are often willing to assume a greater role in self-management support and could fill help to fill the gaps in traditional systems of care. Several studies suggest that targeted services that enhance the role of informal caregivers can improve patients’ self-management and health outcomes.
The goal of these services is to enable caregivers to:
- Identifying emerging problems early while they can be addressed
- Encourage and improve patients’ medication use and self-monitoring
- Assist the patient in understanding and following through with self-care plans recommended by their clinicians
Service Innovation: CarePartners
QUICCC investigators are developing CarePartners – a program that links chronically-ill patients with caregivers living outside of the home.
Patients who use the service receive regular health and behavioral monitoring via automated telephone calls that also provide targeted feedback on reported problems.
The patient’s informal caregiver or CarePartnerreceives reports via e-mail based on the patient’s weekly assessments and have access to a comprehensive Web site with more detailed information about the patient’s chronic illness and how they can help. Urgent health problems are reported to the patient’s health care team via e-mail,fax, and pager
Ongoing research and development
With support from the Blue Cross Blue Shield of Michigan Foundation and the U-M Institute of Gerontology, QUICCC investigators evaluated the feasibility and usefulness of this model for improving self-care support.
Investigators have found that most patients with heart failure are willing and able to identify a CarePartner to assist them in managing their cardiovascular risk factors. Patients receiving care at UMHS and VA Ann Arbor Healthcare System (VAAAHS) are participating with CarePartners from as far away as California and Washington.
A randomized trial to evaluate the impact of this service on patients’ self-care and health outcomes is currently underway with funding from the National VA Health Services Research and Development program.