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The full report is titled “Improving Chronic Disease Care by Adding Laypersons to the Primary Care Team. A Parallel Randomized Trial.” It is in the 6 August 2013 issue of Annals of Internal Medicine (volume 159, pages 176-184). The authors are R. Adair, D.R. Wholey, J. Christianson, K.M. White, H. Britt, and S. Lee.
Does Adding Laypersons to Primary Care Teams Improve Care for Chronic Diseases?. Ann Intern Med. 2013;159:I-28. doi: 10.7326/0003-4819-159-3-201308060-00003
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Published: Ann Intern Med. 2013;159(3):I-28.
Chronic diseases, such as stroke, heart disease, cancer, arthritis, and diabetes, are the leading causes of death and disability in the United States today. They are expensive and sometimes complicated to treat, and patients who have them often do not receive recommended care. Improving care for patients with chronic disease is an important goal, but how to accomplish it efficiently is unclear. Evidence indicates that chronic disease care is best provided by a primary care–led team of physicians and caregivers, but how these teams should be structured is not yet clear.
The researchers wanted to test whether adult patients with chronic disease working with layperson “care guides” would receive better care than patients receiving usual care. The care guides received brief training about chronic diseases and strategies for behavior change.
The study involved 2135 adults aged 18 to 79 years with hypertension, diabetes, or congestive heart failure. About half of the participants had more than 1 of these diseases.
Investigators recruited patients with chronic diseases from 6 primary care clinics in Minnesota starting in July 2010. During an office visit, patients received information about standard care goals for their diseases. They were asked to work toward these goals for 1 year and were randomly assigned to work with or without the help of a care guide to achieve the goals. Researchers measured the percentage of the goals met at baseline and after 1 year.
Care guides used various techniques to help patients. They explained the benefits of meeting goals in lay language, created an environment where patients felt at ease asking questions, called patients after office visits to ensure instructions were understood, and helped develop specific action plans. They also reminded providers and nurses about unmet patient goals and gave providers information about patient medication problems or readiness to quit tobacco use.
After 1 year, patients with care guides had achieved more goals than those who received usual care. Care guide patients reduced unmet goals more than usual care patients (30.1% vs. 12.6%). In particular, care guide patients improved more than usual care patients in meeting several individual clinical goals, including not using tobacco and, for those with diabetes, getting retinal eye examinations and urine tests for protein. In surveys conducted after the study was completed, the care guide patients reported more positive perceptions of their care than the usual care patients in terms of social support, individualized care, help, reinforcement, and understanding of how to improve their health. The estimated cost of the care guide intervention was $286 per patient per year.
Contact with care guides about their patients may have influenced the care delivered by providers to the usual care patients. Participants may not be representative of patients in other areas of the United States. The study's 1-year time frame may have been too short to fully assess the effect of the care guides.
Adding care guides to the primary care team might improve care for some patients with chronic disease at low cost.
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