Correlates of family involvement before and during medical visits among older adults with high-risk diabetes

• Published in: Diabetic medicine Vol. 33; no. 8; pp. 1140 - 1148
• Main Authors: Janevic, M. R., Piette, J. D., Ratz, D. P., Kim, H. M., Rosland, A.-M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2016; Wiley Subscription Services, Inc
• Subjects: Age Factors; Aged; Aged, 80 and over; Appointments and Schedules; Blood pressure; Caregivers; Diabetes; Diabetes Complications - etiology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Linear Models; Male; Medicare; Medication Adherence; Middle Aged; Multivariate Analysis; Patient Health Questionnaire; Trends; United States; United States Department of Veterans Affairs
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13045

Aims To examine the characteristics of patients with diabetes who regularly receive help from a supporter in preparing for and attending medical visits, and the association between this help and clinical risk factors for diabetes complications. Methods We linked survey data about family involvement for patients in the Veterans Health Administration system with poorly controlled Type 2 diabetes (n = 588; mean 67 years; 97% male) with health record data on blood pressure, glycaemic control and prescription‐fill gaps. We used multivariable regression to assess whether supporter presence and, among patients with supporters, supporter role (visit preparation, accompaniment to medical visit or no involvement) were associated with concurrent trends in clinical risk factors over 2 years, adjusting for sociodemographic and health characteristics. Results Most patients (78%) had a main health supporter; of these, more had regular support for preparing for appointments (69%) than were regularly accompanied to them (45%). Patients with preparation help only were younger and more educated than accompanied patients. Support presence and type was not significantly associated with clinical risk factors. Conclusions Family help preparing for appointments was common among these patients with high‐risk diabetes. In its current form, family support for medical visits may not affect clinical factors in the short term. Supporters helping patients engage in medical visits may need training and assistance to have an impact on the clinical trajectory of patients with diabetes. What's new? Patients with diabetes often bring companions to medical visits, but family members may also support patient engagement in other ways, including helping prepare for visits. In a large sample of patients in the Veterans Health Administration system with diabetes, among those with a family health supporter, more patients had regular support for visit preparation (69%) than were regularly accompanied (45%) by the supporter. There was no association between type of support for medical visits and concurrent trends in medication adherence, blood pressure or glycaemic control. Most patients with diabetes report family member involvement in medical visits; interventions to mobilize the potential of this support could be developed and tested.