Summaries for Patients |

Does Adding Laypersons to Primary Care Teams Improve Care for Chronic Diseases? FREE

[+] Article, Author, and Disclosure Information

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.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2013;159(3):I-28. doi:10.7326/0003-4819-159-3-201308060-00003
Text Size: A A A

What is the problem and what is known about it so far?

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.

Why did the researchers do this particular study?

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.

Who was studied?

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.

How was the study done?

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.

What did the researchers find?

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.

What were the limitations of the study?

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.

What are the implications of the study?

Adding care guides to the primary care team might improve care for some patients with chronic disease at low cost.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.