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Kowalczyk M, Yao N, Gregory L, Cheatham J, DeClemente T, Fox K, Ignoffo S, Volerman A. Community health worker perspectives: examining current responsibilities and strategies for success. Arch Public Health 2024; 82:94. [PMID: 38907308 PMCID: PMC11191347 DOI: 10.1186/s13690-024-01313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/02/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Community health worker (CHW) interventions have demonstrated positive impacts globally, with the COVID-19 pandemic further highlighting the potential of CHWs at the frontline to support prevention, outreach, and healthcare delivery. As the workforce expands, understanding the work and capabilities of CHWs is key to design successful interventions. This study examines the perspectives of experienced CHWs in Chicago about their current work and strategies for success. METHODS As part of a community-academic partnership in Chicago, semi-structured interviews were completed with individuals who held positions aligned with CHW. Interviews were conducted between January and April 2022. Questions focused on participants' work and factors contributing to their effectiveness to gain insights into workforce strategies for success to be applied in healthcare and community settings. De-identified transcripts were analyzed using inductive reasoning with codes organized into themes and subthemes under two domains identified a priori. The themes informed a logic model focused on the early stages to support the success of CHWs in their role. RESULTS Fourteen individuals participated in the study. The two predetermined domains in this study were: current work of CHWs and strategies for CHWs to be successful. Five themes were identified about CHWs' current work: providing services, building alliances with clients, establishing and maintaining collaborations, collecting data, and experiencing challenges in role. From their perspectives, all these responsibilities enhance client care and support workforce sustainability efforts. Five themes emerged about strategies for the success of CHWs: background of CHWs, champions to support work of CHWs, materials to perform work of CHWs, preparation for CHW role, and characteristics of CHWs. Participants described key traits CHWs should possess to be hired, individuals who can champion and advocate for their work, and specific materials needed to fulfill responsibilities. They reported that training and familiarity with the community were integral to developing and refining the qualities and skills necessary to be effective in their role. CONCLUSION CHWs play an increasingly important role in enhancing healthcare delivery and improving health outcomes. This study offers a framework for policymakers, communities, and organizations to utilize for preparing CHWs to succeed in their roles.
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Affiliation(s)
- Monica Kowalczyk
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Nicole Yao
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - LaToya Gregory
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Jeannine Cheatham
- Department of Pediatrics, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Tarrah DeClemente
- Chicago Public Schools Office of Student Health and Wellness, 42 W. Madison St, Chicago, IL, USA
| | - Kenneth Fox
- Chicago Public Schools Office of Student Health and Wellness, 42 W. Madison St, Chicago, IL, USA
| | - Stacy Ignoffo
- Sinai Urban Health Institute, 1500 S. Fairfield Ave, Chicago, IL, #1782, USA
| | - Anna Volerman
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA.
- Department of Pediatrics, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA.
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Wees K, Thoma L, Meredith A, Adeoye-Olatunde OA, Gonzalvo J. An assessment of pharmacist perceptions and experiences with community health workers. J Am Pharm Assoc (2003) 2024:102112. [PMID: 38705469 DOI: 10.1016/j.japh.2024.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The American Public Health Association defines a community health worker (CHW) as "a trusted member of and/or has an unusually close understanding of the community served." Both CHWs and pharmacists have shown they are well-equipped to produce positive outcomes in chronic disease management, but there is still a gap in the literature regarding the CHW-pharmacist relationship. OBJECTIVE The objective of this study was to assess and describe pharmacist perceptions and experiences with CHWs. METHODS An online survey was distributed to pharmacists via state and national pharmacy organizations in the following states: Illinois, Indiana, Iowa, Minnesota, Nebraska, and Wisconsin. Descriptive statistics were used to summarize demographics and pharmacist experiences with CHWs. RESULTS The survey received 241 responses and 212 (88.0%) met inclusion criteria. Of the 212 eligible respondents, the survey was sufficiently completed by 163 (76.9%). These 163 complete responses were included in the data analysis. Fifty-eight (35.6%) respondents reported working with a CHW and 105 (64.4%) reported never working with a CHW. Fifty-two (89.7%) respondents who previously worked with a CHW were strongly interested or interested in continuing to work with a CHW. Sixty-one (58.1%) respondents without experience were strongly interested or interested in working with a CHW. The reported improvements seen with the addition of a CHW to the healthcare team included: improved patient empowerment, improved clinical patient outcomes, decreased workload of other health care professionals, increased healthcare knowledge, increased healthcare utilization, and increased medication and/or treatment plan adherence. CONCLUSION Pharmacists recognize the benefit of working with a CHW and their contributions to patient care and want to continue working collaboratively. Collaborative pharmacist-CHW relationships should be a priority for optimizing care through community pharmacies and will require a shift in the current structure of community pharmacy services.
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Nida S, Tyas ASA, Putri NE, Larasanti A, Widoyopi AA, Sumayyah R, Listiana S, Espressivo A. A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia. BMC PRIMARY CARE 2024; 25:82. [PMID: 38468218 PMCID: PMC10926673 DOI: 10.1186/s12875-024-02319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Community health workers (CHWs) have demonstrated capability to improve various health indicators, however, many programmes require support in meeting their objectives due to subpar performance and a high rate of CHW attrition. This systematic review investigated the types of CHWs, their workloads, and supervision practices that contribute to their performance in different countries. METHODS The search was carried out in November 2022 in Medline, Embase, and Neliti for studies published in Indonesian or English between 1986 and 2022 that reported public health services delivered by CHWs who live and serve the community where they live but are not considered health professionals. The findings were synthesised using a thematic analysis to assess key factors influencing the performance of CHWs. RESULTS Sixty eligible articles were included in this review. CHWs were responsible for more than two diseases (n = 35) and up to fifteen, with more than eighteen activities. Their roles covered the human life cycle, from preparation for pregnancy, care for newborns, health for children, adolescents, and productive age to elderly individuals. They were also involved in improving environmental health, community empowerment, and other social issues hindering access to health services. They carried out promotive, preventive, and curative interventions. The CHW-population ratio varied from eight to tens of thousands of people. Some CHWs did not have a clear supervision system. Challenges that were often faced by CHWs included inappropriate incentives, inadequate facilities, insufficient mentoring, and supervision, many roles, and a broad catchment area. Many studies revealed that CHWs felt overburdened and stressed. They needed help to balance their significant work and domestic tasks. CONCLUSIONS Effective planning that considered the scope of work of CHWs in proportion to their responsibilities and the provision of necessary facilities were crucial factors in improving the performance of CHWs. Supportive supervision and peer-supervision methods are promising, however, any CHW supervision required a detailed protocol. This systematic review emphasised the opportunity for CHW management system improvement in Indonesia.
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Affiliation(s)
- Sofwatun Nida
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia.
| | - Agatha Swasti Ayuning Tyas
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Nidya Eka Putri
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Ayudina Larasanti
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aldhea Ayu Widoyopi
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Rima Sumayyah
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Saetia Listiana
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aufia Espressivo
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
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Leviton A, Patel AD, Loddenkemper T. Self-management education for children with epilepsy and their caregivers. A scoping review. Epilepsy Behav 2023; 144:109232. [PMID: 37196451 DOI: 10.1016/j.yebeh.2023.109232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA.
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Gunter KE, Ellingson MK, Nieto M, Jankowski R, Tanumihardjo JP. Barriers and Strategies to Operationalize Medicaid Reimbursement for CHW Services in the State of Minnesota: a Case Study. J Gen Intern Med 2023; 38:70-77. [PMID: 36864272 PMCID: PMC10043123 DOI: 10.1007/s11606-022-07925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
Integrated medical and social care via community health worker (CHW) services is a growing area of interest, particularly among health care organizations that offer care for underserved populations. Establishing Medicaid reimbursement for CHW services is only one step to improve access to CHW services. Minnesota is one of 21 states that authorize Medicaid payment for CHW services. Despite available Medicaid reimbursement for CHW services since 2007, the actual experience of many Minnesota health care organizations in obtaining reimbursement for CHW services has been challenging due to barriers at multiple levels (e.g., clarifying and operationalizing regulation, navigating complexity of billing, building organizational capacity to reach key stakeholders at state agencies and health plans). This paper provides an overview of the barriers and strategies to operationalize Medicaid reimbursement for CHW services in the state of Minnesota, through the experience of a CHW service and technical assistance provider. Based on lessons learned in Minnesota, recommendations are made to other states, payers, and organizations as they navigate processes to operationalize Medicaid payment for CHW services.
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Affiliation(s)
- Kathryn E. Gunter
- Section of General Internal Medicine, University of Chicago, Chicago, IL USA
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Bush K, Patrick C, Elliott K, Morris M, Tiruneh Y, McGaha P. Unsung heroes in health education and promotion: How Community Health Workers contribute to hypertension management. Front Public Health 2023; 11:1088236. [PMID: 36908415 PMCID: PMC9996176 DOI: 10.3389/fpubh.2023.1088236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
Rural communities are noted as having poor health outcomes. Rural areas experience barriers to care primarily due to a lack of resources, including education, health insurance, transportation, and social support. Additionally, poor health outcomes are a consequence of poor health literacy skills. Community Health Workers (CHWs) are utilized as a resource to combat these issues. This study focused on a CHW led Self-Management Blood Pressure (SMBP) program offered through the University of Texas at Tyler Health Science Center. The goal of the program was to improve management of hypertension through awareness, education, navigation, advocacy, and resource assistance. The SMBP program included structured workshops and regular follow-up with participants including connections to community resources and social support. CHWs worked closely with physicians providing bi-directional feedback on referrals and engagement of communities through outreach events. Furthermore, CHWs aided to bridge cultural or linguistic gaps between service providers and community members. Data is provided indicating this CHW-led intervention played a significant role in improving hypertension through education of how to make lifestyle changes that impact overall health and quality of life. Participants gained knowledge encouraging them to create lifelong healthy habits, coping skills, stress management, self-care, and accountability. Through this innovative approach, participants thrived in the supportive and encouraging environment led by CHWs as well as improved their blood pressure management.
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Affiliation(s)
- Kim Bush
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Carlea Patrick
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Kimberly Elliott
- Department of Health Policy, Economics, and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Michael Morris
- Department of Health Policy, Economics, and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Yordanos Tiruneh
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paul McGaha
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
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Reininger BM, Lopez J, Zolezzi M, Lee M, Mitchell-Bennett LA, Xu T, Park SK, Saldana MV, Perez L, Payne LY, Collier C, McCormick JB. Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans. BMJ Open 2022; 12:e063521. [PMID: 36446462 PMCID: PMC9710373 DOI: 10.1136/bmjopen-2022-063521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans by level of engagement in a chronic care management (CCM) program that included community health worker (CHW)-delivered multilevel interventions. The programme complemented clinical care and promoted behaviour changes to improve diabetes self-management. DESIGN Quasiexperimental study. SETTING The study was implemented in the Rio Grande Valley region in the USA. Recruitment was conducted in clinics and community events. All other visits were provided in participant homes and community locations. PARTICIPANTS 5649 adults (aged ≥18 years) with poorly controlled type 2 diabetes who enrolled in a community-delivered CCM programme between September 2013 and 2018. INTERVENTIONS The intervention comprised two components: CHW home visits conducted every 3 months and diabetes self-management education (DSME) classes provided in community locations. PRIMARY OUTCOME MEASURES The primary outcome was haemoglobin A1c (HbA1c) measured at baseline every 3 months for up to 24 months. We first examined changes in HbA1c levels over time. The number of completed CHW and DSME encounters was used to classify participants into engagement groups-high engagement defined as ≥10 encounters (n=2952); low engagement defined as 1-9 encounters (n=2697). We used univariable and multivariable longitudinal linear regression models with a generalised estimating equation method. We tested interactions between engagement groups and time. RESULTS Participants' mean HbA1c decreased from 10.20% at baseline to 8.93% (p<0.0001) at 3 months, remaining stable thereafter. Changes in HbA1c were statistically different between the engagement groups. High engagement participants had lower HbA1c levels over the first 15 months of the follow-up period compared with low engagement participants, as compared at 3 months (-0.44%, 95% CI -0.57% to -0.31%; p<0.0001), 6 months (-0.31%, 95% CI -0.43% to -0.14%; p<0.0001), 9 months (-0.27%, 95% CI -0.42% to -0.13%; p=0.0001), 12 months (-0.23%, 95% CI -0.37% to -0.08%; p=0.0025) and 15 months (-0.32%, 95% CI -0.54% to -0.10%; p=0.0040). At months 18, 21 and 24, the HbA1c differences were not statistically significant (18 months: -0.34%, 95% CI -0.77% to 0.08%; p=0.1086; 21 months: -0.22%, 95% CI -1.00% to 0.56%; p=0.5721; 24 months: -0.42%, 95% CI -1.38% to 0.55%; p=0.3966). CONCLUSIONS Higher engagement in the CCM programme delivered by CHWs and coordinated with clinical care was associated with beneficial improvements in type 2 diabetes control, but both engagement groups showed strong improvements.
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Affiliation(s)
- Belinda M Reininger
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Juliana Lopez
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Maria Zolezzi
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lisa A Mitchell-Bennett
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Tianlin Xu
- Biostatistics, University of Texas School of Public Health, Houston, Texas, USA
| | - Soo Kyung Park
- Department of Biostatistics and Data Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mayra V Saldana
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - LuBeth Perez
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Lisa Y Payne
- School of Public Health, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Cindy Collier
- Public Health College of Nursing and Health Sciences, Texas A&M International University, Laredo, Texas, USA
| | - Joseph B McCormick
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
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Tan TW, Crocker RM, Palmer KNB, Gomez C, Armstrong DG, Marrero DG. A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system. J Foot Ankle Res 2022; 15:56. [PMID: 35932076 PMCID: PMC9356391 DOI: 10.1186/s13047-022-00561-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The mechanisms for the observed disparities in diabetes-related amputation are poorly understood and could be related to access for diabetic foot ulceration (DFU) care. This qualitative study aimed to understand patients’ personal experiences navigating the healthcare system and the barriers they faced. Methods Fifteen semi-structured interviews were conducted over the phone between June 2020 to February 2021. Participants with DFUs were recruited from a tertiary referral center in Southern Arizona. The interviews were audio-recorded and analyzed according to the NIMHD Research Framework, focusing on the health care system domain. Results Among the 15 participants included in the study, the mean age was 52.4 years (66.7% male), 66.7% was from minority racial groups, and 73.3% was Medicaid or Indian Health Service beneficiaries. Participants frequently reported barriers at various levels of the healthcare system. On the individual level, themes that arose included health literacy and inadequate insurance coverage resulting in financial strain. On the interpersonal level, participants complained of fragmented relationships with providers and experienced challenges in making follow-up appointments. On the community level, participants reported struggles with medical equipment. On the societal level, participants also noted insufficient preventative foot care and education before DFU onset, and many respondents experienced initial misdiagnoses and delays in receiving care. Conclusions Patients with DFUs face significant barriers in accessing medical care at many levels in the healthcare system and beyond. These data highlight opportunities to address the effects of diabetic foot complications and the inequitable burden of inadequately managed diabetic foot care.
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Affiliation(s)
- Tze-Woei Tan
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA. .,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA.
| | - Rebecca M Crocker
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Kelly N B Palmer
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Gomez
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA.,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA
| | - David G Marrero
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
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Mottl AK, Alicic R, Argyropoulos C, Brosius FC, Mauer M, Molitch M, Nelson RG, Perreault L, Nicholas SB. KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD. Am J Kidney Dis 2022; 79:457-479. [PMID: 35144840 PMCID: PMC9740752 DOI: 10.1053/j.ajkd.2021.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.
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Song K, Lee A. Factors influencing the effective management of diabetes during humanitarian crises in low- and middle-income countries: a systematic review. Public Health 2021; 199:110-117. [PMID: 34626911 DOI: 10.1016/j.puhe.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/09/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The management of non-communicable chronic diseases such as diabetes mellitus is often poor in humanitarian crisis settings. Poor disease management can have serious long-term consequences. This review sought to identify studies that explored the effectiveness of interventions and the determinants that may improve the management of diabetes in the humanitarian context. STUDY DESIGN A systematic review was conducted of all types of studies that implemented diabetes programmes in humanitarian settings. METHODS MEDLINE, Embase, CINAHL and Web of Science were searched for relevant articles using multiple search terms for relevant studies published in English between 2000 and June 2020. Quality assessments using valid tools, were conducted. A narrative synthesis of the findings was then performed. RESULTS The search yielded 550 citations. After de-duplicating and screening, 19 studies were eligible for inclusion. Most studies were conducted in the Middle East (74%), Asia (16%) and Africa (10%). The interventions reported to improved diabetes care included the mHealth tool, intensive lifestyle intervention, task-shifting, psychosocial support, distribution of glucometers and comprehensive care. Insufficient drug supply, out-of-pocket cost, the complexity of insulin therapy and low adherence to guidelines were identified as barriers. CONCLUSION There is a paucity of evidence on optimal diabetes care in acute crisis and natural disaster settings. The review was constrained by the low quality of the studies included. Nevertheless, it is likely that mHealth can be feasibly utilised, as educational SMS messages are cost-effective and electronic medical records can enhance disease monitoring. In addition, a multidisciplinary approach to care improves glycaemic control and is desirable due to the multifaceted nature of the disease and management required. Several key barriers have been identified that need to be tackled. Overall, the evidence base for diabetes care in humanitarian settings remains sparse, and further research is needed.
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Affiliation(s)
- K Song
- School of Health and Related Research, The University of Sheffield, United Kingdom.
| | - A Lee
- School of Health and Related Research, The University of Sheffield, United Kingdom
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Andersen JA, Felix H, Selig J, Rowland B, Bing W, Hudson J, Niedenthal J, Otuafi H, Riklon S, Azures E, George A, McElfish PA. Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2021; 23:100824. [PMID: 34401596 PMCID: PMC8349743 DOI: 10.1016/j.conctc.2021.100824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker. METHODS This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23). RESULTS The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet. CONCLUSIONS This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Edlen Azures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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12
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Framing the Integration of Community Health Workers Into Health Care Systems Along Health Care and Community Spectrums. J Ambul Care Manage 2021; 44:271-280. [PMID: 34347715 DOI: 10.1097/jac.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research calls for community health worker (CHW) integration within health systems, yet there is no agreement regarding what CHW integration is or guidance for how it can be achieved. This study examines factors associated with CHW integration in community and health care settings using a qualitative descriptive multiple-embedded case study of CHW teams at the University of Illinois at Chicago. Data were collected via semistructured interviews/document review and analyzed using thematic coding and quantitative content analysis. Factors associated with higher clinical integration included culture, communication, protocols, and training while higher community integration was associated with accessibility, relationships, and empathy.
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13
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Sugarman M, Ezouah P, Haywood C, Wennerstrom A. Promoting Community Health Worker Leadership in Policy Development: Results from a Louisiana Workforce Study. J Community Health 2021; 46:64-74. [PMID: 32448981 DOI: 10.1007/s10900-020-00843-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community health workers (CHWs) are effective in improving public health, and many states are developing policy to support the workforce. In 2019, the Louisiana legislature created the CHW Workforce Study Committee (Committee) of at least half CHWs to study the workforce and provide the state with policy recommendations. The Committee followed national best practices in CHW engagement. A CHW and an academic team identified CHWs and employers statewide, administered a survey in partnership with a CHW professional association, and conducted in-depth interviews with CHWs and employers. Descriptive statistics were used to summarize survey data and applied thematic analysis was used to interpret interview transcripts. Sixty-five CHWs and 37 employers participated in the survey. Twenty-one CHWs and 15 employers completed interviews. Survey data indicated that Louisiana CHW roles and activities are consistent with national research. Interviews revealed a lack of knowledge about CHWs among key stakeholders, CHW workforce challenges including lack of community and professional resources, and differing ideas about the value of common workforce development practices such as standardized training and credentialing. Findings suggest a need for widespread education about CHWs and support for CHW participation in professional associations to address common workforce challenges. CHW co-leadership and partnering with a CHW professional association enabled successful study execution and full participation of CHWs in the formation of Committee recommendations. A subset of Committee members, made up of at least half CHWs, continues to meet to expand and support the workforce.
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Affiliation(s)
- Meredith Sugarman
- Center for Healthcare Value and Equity, LA State University Health Sciences Center - New Orleans, 533 Bolivar Street, Room 511, New Orleans, LA, 70112, USA.
| | - Pascaline Ezouah
- Center for Healthcare Value and Equity, LA State University Health Sciences Center - New Orleans, 533 Bolivar Street, Room 507, New Orleans, LA, 70112, USA
| | - Catherine Haywood
- Louisiana Community Health Outreach Network, 1226 N. Broad Street, New Orleans, LA, 70119, USA
| | - Ashley Wennerstrom
- Behavioral and Community Health Sciences; Center for Healthcare Value and Equity, LA State University Health Sciences Center - New Orleans, 533 Bolivar Street, Room 505, New Orleans, LA, 70112, USA
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14
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George S, Silva L, Llamas M, Ramos I, Joe J, Mendez J, Salazar R, Tehan J, Vasquez T, Nealy S, Balcazar H. The Development of a Novel, Standards-Based Core Curriculum for Community Facing, Clinic-Based Community Health Workers. Front Public Health 2021; 9:663492. [PMID: 34164368 PMCID: PMC8215713 DOI: 10.3389/fpubh.2021.663492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/16/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Historically, CHW trainings have been developed to support community-based CHWs. When CHWs have been trained to engage with patients, typically such trainings have been for short term grant funded projects, focusing on a specific health intervention and not for long term, ongoing engagement of CHWs employed in clinical settings. To the best of our knowledge, this is the first such effort to describe the development of a standards-based training curriculum for clinic-based CHWs using a novel conceptual framework. Methods: Our conceptual approach for curricular development has several innovative features including: (1) a foundational consultation process with CHW national experts to inform curricular development approach, process and content; (2) utilization of the CHW Consensus Project (C3 Project) to provide curricular standards and guide learning objectives; (3) integration of three key stakeholder group perspectives (patients, healthcare teams, and healthcare systems); (4) use of popular education principles, aiming to foster a collaborative learning process; (5) integration of adult learning principles which build on learners' experiences, culminating in a modified apprenticeship model and (6) collaboration with clinical partners throughout planning and development of the curriculum. Results: The resulting standards-based curriculum is comprised of 10 modules, which span three areas of focus: (1) Establishing a professional CHW identity and competencies; (2) Outlining the context, processes and key actors in health care settings with whom CHWs will engage; and (3) Identifying the main forces that shape health and health care outcomes of patients/families and communities. Discussion: We highlight four lessons from our curriculum development process that may help other such efforts. First, curricular development should utilize CHW standards, existing training materials, and community-focused principles to inform curricular content and learning outcomes. Second, curricula should support training delivery using experience-based, participatory approaches, consistent with adult education and popular education principles. Third, training development for clinical settings should also draw from clinical CHW experiences and input. Fourth, curricula should support training for key stakeholders and champions in clinical organizations to improve organizational readiness for integrating CHWs into healthcare teams and health systems. Our results contribute to growing research on effective CHW training methods for clinical settings.
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Affiliation(s)
- Sheba George
- Department of Preventive and Social Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States.,Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucero Silva
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Myra Llamas
- Providence Health Systems, Los Angeles, CA, United States
| | - Irma Ramos
- Providence Health Systems, Los Angeles, CA, United States
| | - Justin Joe
- Providence Health Systems, Los Angeles, CA, United States
| | - Juan Mendez
- Providence Health Systems, Los Angeles, CA, United States
| | | | - Jim Tehan
- Providence Health Systems, Los Angeles, CA, United States
| | - Tatiana Vasquez
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Schetema Nealy
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Hector Balcazar
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
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15
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Musoke D, Atusingwize E, Ikhile D, Nalinya S, Ssemugabo C, Lubega GB, Omodara D, Ndejjo R, Gibson L. Community health workers' involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda. Global Health 2021; 17:7. [PMID: 33413500 PMCID: PMC7791672 DOI: 10.1186/s12992-020-00653-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-020-00653-5.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Deborah Ikhile
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Damilola Omodara
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
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16
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Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach. J Ambul Care Manage 2020; 43:55-70. [PMID: 31770186 DOI: 10.1097/jac.0000000000000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.
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17
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Manian N, Wagner CA, Placzek H, Darby BA, Kaiser TJ, Rog DJ. Relationship between intervention dosage and success of resource connections in a social needs intervention. Public Health 2020; 185:324-331. [PMID: 32726729 DOI: 10.1016/j.puhe.2020.05.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/02/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Social needs interventions in medical settings aim to mitigate the effects of adverse social circumstances on health outcomes by connecting vulnerable patients with resources. This study examined the relationship between intervention dosage and the success of resource connections using data from a social needs intervention in multiple clinical settings across the US. STUDY DESIGN The intervention uses a case management approach to connect patients with unmet needs to resources and services in the community. Intervention dosage was conceptualized as the number of contacts between the navigator and the patient, categorized as direct contact (phone vs. in person) and indirect contact (initiated by the navigator vs. patient). Success of the intervention was conceptualized as 'none,' 'partial,' or 'optimal' for each patient, based on the number of social needs the resource connections addressed. METHODS Administrative data were extracted for 38,404 unique patients who screened positive for unmet resource needs between 2012 and 2017. Owing to the large sample size, statistical corrections were made to reduce type I error. RESULTS Multinomial logistic regression analyses showed that higher intervention dosage was related to greater success of resource connections, after adjusting for the patient and site characteristics, and the number of needs (odds ratios ranged from 1.62 to 2.89). In-person contact, although received by only 25% of the patients, was associated with the highest probability of optimal success. CONCLUSIONS This study demonstrates a feasible way to conceptualize an intervention dose for a social needs intervention that uses a case management approach and has implications for how intervention delivery may improve success of resource connections.
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Affiliation(s)
- N Manian
- Westat, 1600 Research Blvd, Rockville, MD 20850, USA.
| | - C A Wagner
- Westat, 1600 Research Blvd, Rockville, MD 20850, USA
| | - H Placzek
- Health Leads, 24 School St, Boston, MA 02108, USA
| | - B A Darby
- Health Leads, 24 School St, Boston, MA 02108, USA
| | - T J Kaiser
- Health Leads, 24 School St, Boston, MA 02108, USA
| | - D J Rog
- Westat, 1600 Research Blvd, Rockville, MD 20850, USA
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18
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Where Is the Break-even Point for Community Health Workers? Using National Data and Local Programmatic Costs to Find the Break-even Point for a Metropolitan Community Health Worker Program. Med Care 2020; 58:314-319. [PMID: 32197027 DOI: 10.1097/mlr.0000000000001273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community health worker (CHW) programs take many forms and have been shown to be effective in improving health in several contexts. The extent to which they reduce unnecessary care is not firmly established. OBJECTIVES This study estimates the number of hospitalizations and emergency department (ED) visits that would need to be avoided to recoup program costs for a CHW program that addressed both medical and social needs. RESEARCH DESIGN A programmatic cost analysis is conducted using 6 different categories: personnel, training, transportation, equipment, facilities, and administrative costs. First, baseline costs are established for the current program and then estimate the number of avoided ED visits or hospitalizations needed to recoup program costs using national average health care estimates for different patient populations. MEASURES Data on program costs are taken from administrative program records. Estimates of ED visit and hospitalization costs (or charges in some cases) are taken from the literature. RESULTS To fully offset program costs, each CHW would need to work with their annual caseload of 150 participants to avoid almost 50 ED visits collectively. If CHW participants also avoided 2 hospitalizations, the number of avoided ED visits needed to offset costs reduces to about 34. CONCLUSIONS Estimates of avoided visits needed to reach the break-even point are consistent with the literature. The analysis does not take other outcomes of the program from the clients' or workers' perspectives into account, so it is likely an upper bound on the number of avoided visits needed to be cost-effective.
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19
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Lewis CM, Gamboa-Maldonado T, Belliard JC, Nelson A, Montgomery S. Preparing for Community Health Worker Integration Into Clinical Care Teams Through an Understanding of Patient and Community Health Worker Readiness and Intent. J Ambul Care Manage 2020; 42:37-46. [PMID: 30499899 PMCID: PMC6278825 DOI: 10.1097/jac.0000000000000261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a rising demand to expand the successful roles community health workers (CHWs) offer into clinical settings (clinic-based community health worker [cCHW]) to support patient services. Using survey data, we evaluated patient and CHW readiness and intent to adopt cCHW clinical care integration. We found CHW and patient readiness to become or utilize a cCHW significantly predicted CHW and patient intent to become or utilize a cCHW; however, in our study, CHWs experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs.
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Affiliation(s)
- Charlotte M Lewis
- Schools of Public Health (Drs Lewis, Gamboa-Maldonado, Belliard, and Nelson) and Behavioral Health (Dr Montgomery), Loma Linda University, Loma Linda, California
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20
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Abstract
PURPOSE OF REVIEW Community health centers (CHCs) provide care to millions of vulnerable patients in the USA, including a disproportionate number with diabetes. Policies affecting diabetes management in CHCs therefore have broad implications for clinical practice and patient outcomes nationwide. We describe prior policies that have influenced diabetes management in CHCs, discuss current policies and programs, as well as present emerging innovations and future directions for diabetes care in this setting. RECENT FINDINGS Domains for current diabetes policies and programs in CHCs include coverage requirements, quality reporting and incentives, prescription discounts, healthy behavior incentives, and team-based care. Policies in these areas affect the management of diabetes at multiple levels, from organizations that support CHCs to individual health centers, and the providers and patients based there. Several domains of interrelated policies and programs impact CHC diabetes management at multiple levels. Stakeholders' understanding of these policies and programs may identify opportunities to improve diabetes care.
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Affiliation(s)
- A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 50 North Medical Dr. 5R341, Salt Lake City, UT, 84132, USA.
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Robert S Nocon
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Matthew J O'Brien
- Department of Internal Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Hsu C, Cruz S, Placzek H, Chapdelaine M, Levin S, Gutierrez F, Standish S, Maki I, Carl M, Orantes MR, Newman D, Cheadle A. Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention. J Gen Intern Med 2020; 35:481-489. [PMID: 31792864 PMCID: PMC7018904 DOI: 10.1007/s11606-019-05397-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Interest is growing in interventions to address social needs in clinical settings. However, little is known about patients' perceptions and experiences with these interventions. OBJECTIVE To evaluate patients' experiences and patient-reported outcomes of a primary care-based intervention to help patients connect with community resources using trained volunteer advocates. DESIGN Qualitative telephone interviews with patients who had worked with the volunteer advocates. Sample and recruitment targets were equally distributed between patients who had at least one reported success in meeting an identified need and those who had no reported needs met, based on the database used to document patient encounters. PARTICIPANTS One hundred two patients. INTERVENTIONS Patients at the study clinic were periodically screened for social needs. If needs were identified, they were referred to a trained volunteer advocate who further assessed their needs, provided them with resource referrals, and followed up with them on whether their need was met. APPROACH Thematic analysis was used to code the data. KEY RESULTS Interviewed patients appreciated the services offered, especially the follow-up. Patients' ability to access the resource to which they were referred was enhanced by assistance with filling out forms, calling community resources, and other types of navigation. Patients also reported that interacting with the advocates made them feel listened to and cared for, which they perceived as noteworthy in their lives. CONCLUSIONS This patient-reported information provides key insights into a human-centered intervention in a clinical environment. Our findings highlight what works in clinical interventions addressing social needs and provide outcomes that are difficult to measure using existing quantitative metrics. Patients experienced the intervention as a therapeutic relationship/working alliance, a type of care that correlates with positive outcomes such as treatment adherence and quality of life. These insights will help design more patient-centered approaches to providing holistic patient care.
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Affiliation(s)
- Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Stephanie Cruz
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Hilary Placzek
- Data Science, Clarify Health Solutions, San Francisco, CA, USA.,Health Leads, Boston, MA, USA
| | | | - Sara Levin
- Contra Costa Health Services, Martinez, CA, USA
| | | | | | - Ian Maki
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | - Allen Cheadle
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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22
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Bui LP, Hill-Briggs F, Durkin N, Apfel A, Ephraim PL, Andon L, Lalani HS, Dunbar L, Appel LJ, Yeh HC. Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes? J Diabetes Complications 2019; 33:445-450. [PMID: 30975464 PMCID: PMC9078057 DOI: 10.1016/j.jdiacomp.2018.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. RESULTS In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08-1.86) and 64% (RR: 1.64; 95% CI: 1.08-2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02-1.42) and 42% (RR:1.42; 95% 1.09-1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): -0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): -0.23% (1.59%)). CONCLUSION In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.
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Affiliation(s)
- Linh Phuong Bui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Felicia Hill-Briggs
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins HealthCareLLC, Glen Burnie, MD, USA
| | - Nola Durkin
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Ariella Apfel
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Patti L Ephraim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hussain S Lalani
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linda Dunbar
- Johns Hopkins HealthCareLLC, Glen Burnie, MD, USA
| | - Lawrence J Appel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Hsin-Chieh Yeh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
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23
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Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen S, Urbanski PB, Yancy WS. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019; 42:731-754. [PMID: 31000505 PMCID: PMC7011201 DOI: 10.2337/dci19-0014] [Citation(s) in RCA: 622] [Impact Index Per Article: 124.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alison B Evert
- UW Neighborhood Clinics, UW Medicine, University of Washington, Seattle, WA
| | | | - Christopher D Gardner
- Stanford Diabetes Research Center and Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - W Timothy Garvey
- Diabetes Research Center, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
- Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | | | | | - Joanna Mitri
- Section on Clinical, Behavioral and Outcomes Research Lipid Clinic, Adult Diabetes Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | | | - Laura Saslow
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI
| | | | | | - William S Yancy
- Duke Diet and Fitness Center, Department of Medicine, Duke University Health System, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
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24
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Hessler D, Bowyer V, Gold R, Shields-Zeeman L, Cottrell E, Gottlieb LM. Bringing Social Context into Diabetes Care: Intervening on Social Risks versus Providing Contextualized Care. Curr Diab Rep 2019; 19:30. [PMID: 31037356 DOI: 10.1007/s11892-019-1149-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Patient social and economic risk information can guide diabetes care through social risk-targeted care (directly intervening on social risk factors) or social risk-informed care (modifying or tailoring care to accommodate social risks). We review evidence supporting these approaches and highlight critical gaps in the current evidence. RECENT FINDINGS Literature is scarce on isolated social care interventions and the impact on glycemic control is unclear, while blended social-behavioral interventions more consistently point to reductions in HbA1c. Social risk-informed care naturally occurs at low rates, yet holds potential to improve care. Momentum is building around programs designed to intervene on social risk factors and/or to contextualize care based on social context. Future work will need to isolate the impacts of these programs, clarify the pathways through which social care programs can improve outcomes, and identify provider barriers and facilitators to using social risk information in care.
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Affiliation(s)
- Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA, 94143, USA.
| | - Vicky Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA, 94143, USA
| | - Rachel Gold
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- OCHIN Inc., Portland, OR, USA
| | - Laura Shields-Zeeman
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA, 94143, USA
| | | | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA, 94143, USA
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Barriers and Facilitators in Implementing Non-Face-to-Face Chronic Care Management in an Elderly Population with Diabetes: A Qualitative Study of Physician and Health System Perspectives. J Clin Med 2018; 7:jcm7110451. [PMID: 30463310 PMCID: PMC6262419 DOI: 10.3390/jcm7110451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected from interviews with physicians, health system administrators, and other healthcare staff about chronic care management for elderly people with diabetes co-morbid with other chronic conditions in light of new programs intended to reduce barriers by incentivizing care encounters that take place through telephone and electronic communications (non-face-to-face care). Results indicate that health system personnel view non-face-to-face care as potentially providing value for patients and addressing systemic needs, yet challenging to implement in practice. Barriers and facilitators to this approach for managing diabetes and chronic care management for its complications are presented, with consideration to different types of health systems, and recommendations are provided for implementation.
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Hsu C, Hertel E, Johnson E, Cahill C, Lozano P, Ross TR, Ehrlich K, Coleman K, BlueSpruce J, Cheadle A, Matthys J, Chapdelaine M, Gray M, Tufte J, Robbins M. Evaluation of the Learning to Integrate Neighborhoods and Clinical Care Project: Findings from Implementing a New Lay Role into Primary Care Teams to Address Social Determinants of Health. Perm J 2018; 22:18-101. [PMID: 32392126 DOI: 10.7812/tpp/18-101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health systems increasingly recognize the impact of social determinants of health such as access to housing, transportation, and nutritious food. Lay health workers have been used to address patients' social determinants of health through resource referral and goal setting in targeted populations, such as individuals with diabetes. However, we know of no studies that evaluate this type of role for a general primary care population. OBJECTIVE To assess the implementation and impact of the Community Resource Specialist (CRS) role in Kaiser Permanente Washington. METHODS We analyzed data from staff interviews, patient focus groups, clinic site visits, patient surveys, the electronic health record, and administrative sources. RESULTS Satisfaction with CRSs was high, with 92% of survey respondents choosing "very satisfied" or "somewhat satisfied." Of patients with a resource referral and follow-up encounter, 45% reported using the resource (n = 229) and 86% who set a goal and had a follow-up encounter (n = 218) progressed toward their goal. Primary care teams reported workload easing. Patients who used CRSs and participated in focus groups reported behavior changes and improved health, although no changes were detected from electronic health records or patient survey data. Key learnings include the need to clearly define the CRS role, ensure high visibility to clinical staff, and facilitate personal introductions of patients (warm handoffs). CONCLUSION Adding an individual to the primary care team with expertise in community resources can increase patient satisfaction, support clinicians, and improve patients' perceptions of their health and well-being.
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Affiliation(s)
- Clarissa Hsu
- Assistant Investigator at the Center for Community Health and Evaluation at the Group Health Research Institute in Seattle, WA
| | - Erin Hertel
- Senior Research Associate at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Eric Johnson
- Biostatistician at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Carol Cahill
- Communication and Analytics Consultant at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Paula Lozano
- Senior Investigator at Group Health Research Institute and Assistant Medical Director of Preventive Care at Group Health in Seattle, WA
| | - Tyler R Ross
- Director of Information Technology at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Kelly Ehrlich
- Project Manager at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Katie Coleman
- Assistant Investigator at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - June BlueSpruce
- Project Manager at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Allen Cheadle
- Director of the Center for Community Health and Evaluation for the Group Health Research Institute in Seattle, WA
| | - Juno Matthys
- Research Associate at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Michelle Chapdelaine
- Research Associate in the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Marlaine Gray
- Acting Assistant Investigator at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Janice Tufte
- Patient Co-Investigator at the Group Health Research Institute in Seattle, WA
| | - Michele Robbins
- Patient Co-Investigator at the Group Health Research Institute in Seattle, WA
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Egbujie BA, Delobelle PA, Levitt N, Puoane T, Sanders D, van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS One 2018; 13:e0198424. [PMID: 29856846 PMCID: PMC5983553 DOI: 10.1371/journal.pone.0198424] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence. OBJECTIVES This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions. METHOD The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O'Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed. RESULTS 1008 studies were identified of which 54 full text articles were selected. Most (53) of the selected studies were in HIC and targeted mostly minority populations in low resource settings. CHWs were mostly deployed to provide education, support, and advocacy. Structured curriculum based education was the most frequently reported service provided by CHWs to support T2DM self-management. Support services included informational, emotional, appraisal and instrumental support. Models of CHW care included facility linked nurse-led CHW coordination, facility-linked CHW led coordination and standalone CHW interventions without facility interaction. CONCLUSION CHWs play several roles in T2DM self-management, including structured education, ongoing support and health system advocacy. Preparing and coordinating CHWs for these roles is crucial and needs further research and strengthening.
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Affiliation(s)
| | - Peter Arthur Delobelle
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Chronic Disease Initiative for Africa, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med 2018; 16:240-245. [PMID: 29760028 PMCID: PMC5951253 DOI: 10.1370/afm.2208] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/13/2017] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. We discuss implications for community health worker training and clinical support in primary care.
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Affiliation(s)
- Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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29
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Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, Perel P, Legido-Quigley H. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One 2018; 13:e0195086. [PMID: 29596495 PMCID: PMC5875848 DOI: 10.1371/journal.pone.0195086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. METHODS AND FINDINGS A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. CONCLUSIONS This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
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Affiliation(s)
- Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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30
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Hughes MM, Yang E, Ramanathan D, Benjamins MR. Community-Based Diabetes Community Health Worker Intervention in an Underserved Chicago Population. J Community Health 2018; 41:1249-1256. [PMID: 27286843 DOI: 10.1007/s10900-016-0212-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Community Health Worker (CHW) model has been used to combat disparities in healthcare access by utilizing community members as healthcare liaisons to promote improved community health. CHW interventions have been effective in improving diabetes management. This case study reports on a low-intensity CHW intervention in a predominantly Hispanic and non-Hispanic Black population in two Chicago neighborhoods: North Lawndale and South Lawndale. CHWs conducted door-to-door outreach and, for individuals with self-reported type 2 diabetes, offered home visits at baseline and one-year follow-up to provide diabetes education, create an individual management strategy, and refer to clinic-based support services. During 2012, 459 participants were enrolled, with 343 completing follow-up visits in 2013 (75 % retention). The mean HbA1c decrease was 0.5 %. At follow-up, participants were less likely to be depressed, to forget to take their diabetes medications, and were more likely to report higher social support and score higher on an assessment of diabetes knowledge. Patients who were younger, Hispanic, had uncontrolled diabetes, and had lower levels of diabetes self-care at baseline demonstrated increased odds of a significant HbA1c decrease with the intervention than patients without these characteristics. This study demonstrates the effectiveness of a home-based, low-intensity CHW intervention in medically underserved communities, and identifies population groups who might benefit the most from future similar CHW interventions.
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Affiliation(s)
- Michelle M Hughes
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA.
| | - Eric Yang
- Chicago Medical School, North Chicago, IL, USA
| | - Dharani Ramanathan
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA
- Chicago Medical School, North Chicago, IL, USA
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Rogers EA, Manser ST, Cleary J, Joseph AM, Harwood EM, Call KT. Integrating Community Health Workers Into Medical Homes. Ann Fam Med 2018; 16:14-20. [PMID: 29311170 PMCID: PMC5758315 DOI: 10.1370/afm.2171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/28/2017] [Accepted: 07/21/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. METHODS We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics. RESULTS Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient. CONCLUSIONS We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce.
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Affiliation(s)
- Elizabeth A Rogers
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sarah Turcotte Manser
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Joan Cleary
- Minnesota Community Health Worker Alliance, St Paul, Minnesota
| | - Anne M Joseph
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Eileen M Harwood
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Kathleen T Call
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Falbe J, Friedman LE, Sokal-Gutierrez K, Thompson HR, Tantoco NK, Madsen KA. "She Gave Me the Confidence to Open Up": Bridging Communication by Promotoras in a Childhood Obesity Intervention for Latino Families. HEALTH EDUCATION & BEHAVIOR 2017; 44:728-737. [PMID: 28851237 DOI: 10.1177/1090198117727323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Childhood obesity is a public health threat that disproportionally affects Latino youth in the United States. Active and Healthy Families (AHF) is a culturally tailored, family-based program for addressing obesity disparities in a predominantly immigrant Latino population. AHF was the first primary care, culturally tailored intervention for Latino children to significantly reduce BMI in a randomized controlled trial. The 10-week AHF intervention reduced BMI (kg/m2) among overweight or obese children by 0.5, compared with an increase of 0.3 in the control group, yielding a -0.8 difference ( p < .01). A unique aspect of the program is its provider team: a physician, dietitian, and promotora. Because early feedback from families highlighted the importance of promotoras specifically, we sought to understand the unique mechanisms of promotora effectiveness in AHF. We conducted in-depth, semistructured interviews with the AHF providers ( n = 5) and parent participants ( n = 23) by phone between November 2012 and May 2013. In a grounded theory analysis, three main categories encompassing five themes emerged: (a) bridging communication by promotoras; (b) promotoras' personal qualities, including themes of kindness and caring and shared experiences with patients; and (c) impactful task performance, including themes of motivation, positive environment, and self-efficacy. Together, the themes serve as the basis of a conceptual model illustrating the process through which promotoras may enhance the impact of team-based obesity programs for the Latino community. Because this study identifies the specific ways through which promotoras can bridge cultural, linguistic, and other divides, it may inform development and dissemination of evidence-based approaches for obesity prevention in the Latino community.
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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Portillo MC, Kennedy A, Todorova E, Regaira E, Wensing M, Foss C, Lionis C, Vassilev I, Goev V, Rogers A. Interventions and working relationships of voluntary organisations for diabetes self-management: A cross-national study. Int J Nurs Stud 2017; 70:58-70. [PMID: 28236688 PMCID: PMC5754322 DOI: 10.1016/j.ijnurstu.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Diabetes has become a challenging health priority globally. Given the tensions of financially burdened health systems in Europe the mobilisation of community resources like voluntary organisations and community groups is seen as a health policy strategy to sustain the management of long-term conditions like diabetes. However, little is known about how this is happening in practice in Europe. OBJECTIVES To explore diabetes self-management interventions undertaken or promoted by voluntary organisations and community groups in Europe; and describe the types of working relationships between these organisations, European health systems and users when implementing diabetes self-management programmes in different areas. DESIGN A mixed method study (survey/qualitative interviews) was undertaken. This research formed part of a European project (7th Framework programme of the European Commission) exploring the link between resources, like community organisations, and peoples' capacities to manage long-term conditions. SETTINGS Six European countries (Bulgaria, Greece, Norway, Spain, the Netherlands and the United Kingdom) participated in the study. Three areas: deprived urban area, a relatively affluent urban area and a deprived rural area were purposefully selected. PARTICIPANTS Through a purposeful sample and bottom up strategies 749 representatives of voluntary organisations and community groups were recruited from the geographical areas above. Organisations with at least three members, existing for at least one year that could provide information or other type of support directly or indirectly relevant to patients with diabetes were included. METHODS Participants completed a 15 item questionnaire for the survey (n=749) and a voice recorded semi structured interview (n=300). Data collection focused on the type of activities and roles developed to promote health, and relationships and communication channels between organisations, health services and users. Descriptive and comparative statistical and qualitative content analyses were used. RESULTS Participants perceived they had better reach of people with health needs than health providers, filled the administration gaps left in their capacity to deal with basic diabetes practical needs, humanized care, and acted as mediators between services and communities. There were significant differences between countries in relation to the types of activities (p-value<0.001), roles (p-value<0.001) and funding sources (p-value<0.001) of organisations concerning diabetes self-management. In non-affluent countries organisations tend to promote social activities twice more often. CONCLUSIONS Community and voluntary organisations provide complimentary and on-going support in diabetes management. This involves a shift from focusing on the illness to also longing for social cohesion, sense of community and wellbeing in diabetes health practices and policies.
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Affiliation(s)
- Mari Carmen Portillo
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK.
| | - Anne Kennedy
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Elka Todorova
- Department of Sociology, University of National and World Economy, Sofia, Bulgaria
| | - Elena Regaira
- Quality Department, University Clinic of Navarra, Pamplona, Spain
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Foss
- Institute of Health and Society, University of Oslo, Norway
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Ivaylo Vassilev
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Valentin Goev
- Department of Statistics, University of National and World Economy, Sofia, Bulgaria
| | - Anne Rogers
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
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Lofters AK, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement. Patient Prefer Adherence 2017; 11:495-503. [PMID: 28331296 PMCID: PMC5352230 DOI: 10.2147/ppa.s127147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. MATERIALS AND METHODS Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. RESULTS Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. DISCUSSION Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
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Affiliation(s)
- AK Lofters
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Department of Family and Community Medicine
- Centre for Urban Health Solutions, St Michael’s Hospital
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto
| | - V Prakash
- Screening Saves Lives Program, Canadian Cancer Society, Mississauga
| | - L Banerjee
- Wise Elephant Family Health Team, Brampton
| | - P Bansal
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Goel
- Wise Elephant Family Health Team, Brampton
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Dunn
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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Maleka BK, Van Der Linde J, Glascoe FP, Swanepoel DW. Developmental Screening—Evaluation of an m-Health Version of the Parents Evaluation Developmental Status Tools. Telemed J E Health 2016; 22:1013-1018. [DOI: 10.1089/tmj.2016.0007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Boledi K. Maleka
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Jeannie Van Der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | | | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia
- Australia Ear Science Institute Australia, Subiaco, Australia
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Mayer MK, Urlaub DM, Guzman-Corrales LM, Kowitt SD, Shea CM, Fisher EB. "They're Doing Something That Actually No One Else Can Do": A Qualitative Study of Peer Support and Primary Care Integration. J Ambul Care Manage 2016; 39:76-86. [PMID: 26650748 DOI: 10.1097/jac.0000000000000079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peer support (PS) is a strategy for improving quality of care for people with chronic disease and is increasingly being integrated with primary care. We conducted semistructured qualitative interviews with 18 staff members from 4 practices that have integrated PS and primary care. From these interviews, we identified several benefits of PS and primary care integration as well as challenges to integrating and sustaining PS programs. We also identified key considerations and strategies for facilitating integration. Strategies for developing messaging to promote understanding of the unique role of peer supporters are discussed.
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Affiliation(s)
- Melissa K Mayer
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas (Mss Mayer, Urlaub, Guzman-Corrales, and Kowitt and Dr Fisher); and Health Behavior (Mss Mayer, Urlaub, Guzman-Corrales, and Kowitt and Dr Fisher) and Department of Health Policy and Management (Dr Shea), Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Dillon E, Panattoni L, Meehan A, Chuang J, Wilson C, Tai-Seale M. Using Unlicensed Health Coaches to Improve Care for Insured Patients with Diabetes and Hypertension: Patient and Physician Perspectives on Recruitment and Uptake. Popul Health Manag 2015; 19:332-40. [PMID: 26674597 DOI: 10.1089/pop.2015.0095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health coach programs using low-cost unlicensed providers have largely targeted uninsured or underserved populations, raising questions about uptake and effectiveness for insured patients. This observational study evaluated the referral process, uptake, and effectiveness of a health coach program for patients with diabetes and/or hypertension at a multispecialty clinic. Data included appointment observations; interviews with patients, physicians, and health coaches; patient and physician characteristics; and measures of utilization and clinical outcomes. Out of 1313 eligible patients, 308 (23.5%) were referred over a 12-month period and 169 (54.9%) had at least 1 health coach appointment. Although the health coach program did not change patients' biometrics, physicians and patients reported improved care processes and reduced physician workload. Barriers to enrollment included variability in physician referral practices, patient willingness, and scheduling difficulties. Modifications to physician and health coach workflow are needed to determine the program's true effectiveness.
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Affiliation(s)
- Ellis Dillon
- 1 Palo Alto Medical Foundation Research Institute , Mountain View, California
| | | | - Amy Meehan
- 1 Palo Alto Medical Foundation Research Institute , Mountain View, California
| | - Judith Chuang
- 1 Palo Alto Medical Foundation Research Institute , Mountain View, California
| | - Caroline Wilson
- 1 Palo Alto Medical Foundation Research Institute , Mountain View, California
| | - Ming Tai-Seale
- 1 Palo Alto Medical Foundation Research Institute , Mountain View, California
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Ayala GX, Ibarra L, Cherrington AL, Parada H, Horton L, Ji M, Elder JP. Puentes hacia una mejor vida (Bridges to a Better Life): Outcome of a Diabetes Control Peer Support Intervention. Ann Fam Med 2015; 13 Suppl 1:S9-17. [PMID: 26304977 PMCID: PMC4648133 DOI: 10.1370/afm.1807] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Peer support can promote diabetes control, yet research on feasible and effective peer support models is lacking. This randomized controlled trial tested a volunteer-based model of peer support for diabetes control. METHODS Thirty-four volunteer peer leaders were recruited and trained to provide support to 5 to 8 patients each through telephone contact, in-person, individual, and group support. Planned dose was 8 contacts, preferably in the first 6 months. Patients with uncontrolled diabetes were randomly sampled from the medical records of 3 community clinics. After a baseline interview and medical records review to obtain baseline values for the primary outcome, HbA1c, 336 patient participants were randomly assigned to a 12-month peer support intervention or usual care. The assessment protocol was repeated at 6 and 12 months after baseline. RESULTS Thirty peer leaders delivered an average of 4 contacts each per assigned participant (range 1-24). Despite the lack of intervention fidelity, the intervention was effective at reducing glycated hemoglobin (HbA1c) among intervention as compared with usual care participants (P=0.05). Similar trends were observed in frequency of meeting fruit and vegetable guidelines (P =0.09), a secondary outcome. Counterintuitively, usual care participants reported checking their feet more days out of 7 than intervention participants (P =0.03). CONCLUSIONS Given the modest changes we observed, combined with other evidence for peer support to promote diabetes control, additional research is needed on how to modify the system of care to increase the level of peer support delivered by volunteers.
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Affiliation(s)
- Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Lucy Horton
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Ming Ji
- University of South Florida College of Nursing, Tampa, Florida
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
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Portillo MC, Regaira E, Pumar-Méndez MJ, Mujika A, Vassilev I, Rogers A, Wensing M, Foss C, Ruud Knutsen I, Todorova E, Roukova P, Kennedy A, Serrano M, Lionis C, Angelaki A, Patelarou E, Koetsenruijter J. Voluntary Organizations and Community Groups as New Partners in Diabetes Self-management and Education: A Critical Interpretative Synthesis. DIABETES EDUCATOR 2015; 41:550-68. [PMID: 26160829 DOI: 10.1177/0145721715594026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to critically review the literature on the role and work of voluntary organizations and community groups and volunteers in diabetes self-management programs. It seeks to explain how these organizations are located and could be integrated further within a broader system of support. METHODS A critical interpretative synthesis of the literature was undertaken as part of the conceptual development of a European research project. Evidence (2000-November 2014) was searched in databases, with the use of key terms, and limited to the languages of the participating countries. This was supplemented by an additional hand search and snowballing technique. A total of 21 articles were included in the review. RESULTS Evidence regarding the involvement of voluntary organizations in diabetes self-management programs mainly related to: the nature and remit of their work, responsibilities, and attributes; key strategies of programs accounting for success; motivations/barriers for engaging in volunteering participation; relationships between volunteers and users; and connections/tensions with formal services. CONCLUSIONS This review has uncovered a range of facets of voluntary organizations and community groups relevant for supporting diabetes self-management such as the context within which they act and the nature of relationships developed with community and health services. The principles of "assistance, support, sharing, and link" seem essential for this voluntary initiative in self-management to establish effective reciprocal collaboration with health professionals.
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Affiliation(s)
- Mari Carmen Portillo
- Faculty of Health Sciences, University of Southampton, Hampshire, UK (Associate Prof Portillo)
| | - Elena Regaira
- Intensive Care Unit, Clinica Universidad de Navarra, Pamplona, Spain (Ms Regaira)
| | | | - Agurtzane Mujika
- School of Nursing, University of Navarra, Pamplona, Spain (Dr Pumar, Dr Mujika)
| | - Ivaylo Vassilev
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK (Dr Vassilev, Prof Rogers, Prof Kennedy)
| | - Anne Rogers
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK (Dr Vassilev, Prof Rogers, Prof Kennedy)
| | - Michel Wensing
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands (Prof Wensing, Mr Koetsenruijter)
| | - Christina Foss
- Institute of Health and Society, University of Oslo, Olso, Norway (Prof Foss, Dr Knutsen)
| | - Ingrid Ruud Knutsen
- Institute of Health and Society, University of Oslo, Olso, Norway (Prof Foss, Dr Knutsen)
| | - Elka Todorova
- Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria (Prof Todorova)
| | - Poli Roukova
- Department of Economic and Social Geography, NIGGG, Bulgaria Academy of Sciences, Sofia, Bulgaria (Ms Roukova)
| | - Anne Kennedy
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK (Dr Vassilev, Prof Rogers, Prof Kennedy)
| | - Manuel Serrano
- Education, Health and Society Foundation, Murcia, Spain (Dr Serrano)
| | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece (Prof Lionis, Ms Angelaki)
| | - Agapi Angelaki
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece (Prof Lionis, Ms Angelaki)
| | - Evridiki Patelarou
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK (Dr Patelarou)
| | - Jan Koetsenruijter
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands (Prof Wensing, Mr Koetsenruijter)
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Abstract
Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.
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Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
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Sepers CE, Fawcett SB, Lipman R, Schultz J, Colie-Akers V, Perez A. Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-management Education Within Four Patient-Centered Medical Homes. DIABETES EDUCATOR 2015; 41:328-42. [PMID: 25801900 DOI: 10.1177/0145721715577638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study is to measure the implementation and effects of a multisite coordinated care approach that delivered diabetes self-management education (DSME) and diabetes self-management support (DSMS) for disadvantaged patients within 4 patient-centered medical homes (PCMH). METHODS A total of 173 patients (69.9% African American, 26.0% Caucasian, and 4.1% other) experienced elements of the intervention, which featured DSME and coordinated care. Key informant interviews with PCMH site staff were used to capture, code, and characterize activities related to implementation and sustainability of the intervention. Outcome measures collected at baseline and at 6 months included clinical health indicators, A1C, body mass index (BMI), blood pressure, and lipids, as well as the AADE7 Behaviors. RESULTS A statistically significant decrease occurred in A1C and BMI within 6 months for participants within 1 PCMH. This improvement among clinical health outcomes was associated with the frequency of services provided (eg, DSME, patient support). CONCLUSION Integrating and delivering DSME and DSMS within coordinated care settings have the potential to improve PCMH practice and associated clinical health outcomes for populations experiencing health disparities.
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Affiliation(s)
- Charles E Sepers
- University of Kansas Work Group for Community Health and Development, Lawrence, Kansas (Mr Sepers, Dr Fawcett, Dr Schultz, Dr Collie-Akers)
| | - Stephen B Fawcett
- University of Kansas Work Group for Community Health and Development, Lawrence, Kansas (Mr Sepers, Dr Fawcett, Dr Schultz, Dr Collie-Akers)
| | - Ruth Lipman
- American Association of Diabetes Educators, Chicago, Illinois (Dr Lipman)
| | - Jerry Schultz
- University of Kansas Work Group for Community Health and Development, Lawrence, Kansas (Mr Sepers, Dr Fawcett, Dr Schultz, Dr Collie-Akers)
| | - Vicki Colie-Akers
- University of Kansas Work Group for Community Health and Development, Lawrence, Kansas (Mr Sepers, Dr Fawcett, Dr Schultz, Dr Collie-Akers)
| | - Alexandra Perez
- Nova Southeastern University College of Pharmacy, Davie, Florida (Dr Perez)
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Stoneman A, Atkinson D, Davey M, Marley JV. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Serv Res 2014; 14:481. [PMID: 25288282 PMCID: PMC4282197 DOI: 10.1186/1472-6963-14-481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Methods Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. Results A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Conclusions Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
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Affiliation(s)
- Alice Stoneman
- Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia.
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