Innovative, culturally tailored strategies are needed to extend diabetes education and support efforts in low-resourced primary care practices serving racial/ethnic minority groups. A randomized controlled trial examined the effect of a diabetes self-care coaching intervention delivered by medical assistants and the joint effect of intervention and ethnicity over time. The randomized repeated-measures design included 270 low-income African American and Hispanic/Latino patients with type 2 diabetes. The one-year clinic- and telephone-based medical assistant coaching intervention was culturally tailored and guided by theoretical frameworks. A1C was obtained, and a self-care measure was completed at baseline, 6 months, and 12 months. Data were analyzed using mixed-effects models with and without adjustment for covariates. There was significant overall improvement in mean self-care scores across time, but no intervention effect. Results revealed differences in self-care patterns across racial/ethnic subgroups. No differences were found for A1C levels across time or group.
Purpose
The purpose of this study was to evaluate the impact of an innovative intervention that utilized a certified medical assistant with specific diabetes training to work with a multidisciplinary diabetes care team to help provide basic diabetes education and self-care support in low-income minority populations with type 2 diabetes.
Methods
Enrolled participants were randomized to either the medical assistant coaching (MAC) group (N = 25) or the treatment as usual (TAU) group (N = 25). Deidentified data was obtained on a matched no contact control (NCC) group (N = 50).
Results
Analysis of covariance (ANCOVA) comparisons revealed no significant differences between the 3 groups on A1C, but a trend was observed. A1Cs decreased across time for the MAC group, while increasing for the TAU and NCC groups. ANCOVA comparisons also indicated that the MAC group experienced significantly greater increases in perceived empowerment and a larger, although non-significant, reduction in perceived diabetes related problems than the TAU group.
Conclusions
This randomized controlled pilot study suggests that the inclusion of a medical assistant self-care coach as part of the diabetes care team holds promise in improving outcomes and should be further examined in a large-scale study.
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