Dana Beth Weinberg, Ph.D., R. William Lusenhop, M.S.W., and Jody Hoffer Gittell, Ph.D.
Social, economic, and technological changes in the world of health care have shifted more responsibility for medical care into the hands of informal caregivers. These individuals—usually patients' family members or friends—are often asked to play an active role in managing care, performing medical interventions, and dispensing medications, despite the fact that many receive insufficient instruction or support from physicians, nurses, or other formal providers.
In "Coordination Between Formal Providers and Informal Caregivers," (Health Care Management Review, April–June 2007), lead author Dana Beth Weinberg, Ph.D., of Queens College, and researchers R. William Lusenhop, M.S.W., Jody Hoffer Gittel, Ph.D., of Brandeis University, and Cori M. Kautz, M.A., of Abt Associates, explore the coordination between formal providers and informal caregivers. Better communication, they find, prepares caregivers to effectively provide and manage care—leading, in turn, to better outcomes for patients.
In this Commonwealth Fund–supported study, the researchers followed 222 knee-replacement patients at Brigham and Women's Hospital in Boston. This procedure was chosen, say the researchers, because "although the surgery is rather routine and typically successful, patients undergo a care and recovery process that spans multiple settings," making effective communication and coordination critical. Patients were surveyed before and 12 weeks after surgery to assess outcomes. Caregivers were surveyed at six weeks after surgery.
To measure caregivers' preparation to manage and provide care, they were asked questions related to continuity (e.g., if the results of surgery or the purpose of medications were explained in a way caregivers could understand). Finally, to measure outcomes, patients were surveyed about freedom from pain, functional status, and mental health.
The current environment of constrained resources, however—because of regulations and reimbursement procedures—have limited providers' ability to develop and maintain relationships with patients, other providers, and caregivers. In addition, long-term relationships with a single practitioner are increasingly being replaced with brief encounters with various providers. Consistently assigning the same providers to patients and caregivers can help to foster a sense of continuity, say the authors, although they concede this is not always possible. Instead, patients and caregivers may be able to develop an ongoing relationship with a provider organization. "In a context of constrained resources and brief encounters, managing task, human, and informational interdependencies requires dedicated resources and support for providers, patients, and caregivers," the authors conclude.