A Randomized Trial of Mobile Health Support for Heart Failure Patients and Their Informal Caregivers. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Piette, John D.; Striplin, Dana; Marinec, Nicolle; Chen, Jenny; Aikens, James E.
• Is Part Of: Medical care. Volume 53:Issue 8(2015)
• Publication Date: 2015-08
• Subjects: Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000378
• Languages: English
• ISSNs: 0025-7079

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers' efforts.</p> </sec> <sec> <title>Objectives:</title> <p>To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management.</p> </sec> <sec> <title>Research Design:</title> <p>Randomized comparative effectiveness trial.</p> </sec> <sec> <title>Subjects:</title> <p>A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a "CarePartner" or informal caregiver outside their household.</p> </sec> <sec> <title>Intervention:</title> <p>Patients randomized to "standard mHealth" received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. "mobile health+CarePartner" (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners.</p> </sec> <sec> <title>Measures:</title> <p>At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support.</p> </sec> <sec> <title>Results:</title> <p>mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both <italic>P</italic>⩽0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (<italic>P</italic>⩽0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all <italic>P</italic><0.05). mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (<italic>P</italic>=0.049) and greater involvement in medication adherence at both endpoints (both <italic>P</italic>⩽0.032).</p> </sec> <sec> <title>Conclusions:</title> <p>When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners' engagement in self-care.</p> </sec> </abstract>