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Vaughan EM, Naik AD, Amspoker AB, Johnston CA, Landrum JD, Balasubramanyam A, Virani SS, Ballantyne CM, Foreyt JP. Mentored implementation to initiate a diabetes program in an underserved community: a pilot study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002320. [PMID: 34385148 PMCID: PMC8362735 DOI: 10.1136/bmjdrc-2021-002320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Community clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic. RESEARCH DESIGN AND METHODS Participants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes. RESULTS Phase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: -0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (p<0.001-0.002). Phase II: participants had significant reductions in HbA1c (mean change: -0.78%, p=0.006), diastolic blood pressure (p=0.004), body mass index (0.012), weight (p=0.010), medication non-adherence (p<0.001), and six ADA measures (p=0.007-0.005). Phase I intervention versus phase II outcomes were comparable. CHWs improved knowledge from pre-test to post-tests (p<0.001). CONCLUSIONS A novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.
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Affiliation(s)
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Amber B Amspoker
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Joshua D Landrum
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | | | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | | | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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