Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010–2014

Nelson, Karin M.; Taylor, Larry E.; Silverman, Julie; Kiefer, Meghan M.; Hebert, Paul L.; Lessler, Dan; Krieger, James

doi:10.5888/pcd14.160344

Cited by 29 publications

(29 citation statements)

References 27 publications

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“…A review of telephone-based diabetes management by lay health workers judged the evidence to be weak [12]. A randomized trial of telephone-based diabetes counseling by CHWs in a local health department reported no improvement in HbA1c control among low income subjects [13]. CHW support may also require individualized in-person encounters; a randomized trial of group-based diabetes education by CHWs for Hispanics with uncontrolled diabetes did not reduce HbA1c [14].…”

Section: Discussionmentioning

confidence: 99%

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

et al. 2020

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Community health workers (CHWs) can reduce health disparities for low income patients but type of contact and outcomes has had limited study. Low-income Hispanic primary care patients with hemoglobin A1c [HbA1c] ≥ 9% received care managment (CM) over 6 months classified as: (CM1) telephone only; (CM2) clinic visit but no calls; (CM3) clinic visit with calls; and (CM4) ≥ 2 visits ± calls. Type of CM delivery and time to DM control (HbA1c < 9%) examined in Cox proportional hazards model and more rapid control within 6 months using logistic regression. Models adjusted for demographics, clinical, and health care variables. At baseline, 523 patients had mean HbA1c 10.9% (SD = 1.7%), mean age 57.9 years (SD = 10), 58.5% women, 87.6% Hispanic, and 55.5% uninsured. CM types for patients: 51 (9.8%) CM1; 192 (36.7%) CM2; 44 (8.4%) CM3; and 236 (45.4%) CM4. Median time to HbA1c control was 197 days (95% CI [71, 548]) and 41.5% achieved control within 6 months. Compared with CM1, control was more rapid for CM2 (Hazard ratio [HR] 1.45, 95% CI [1.01, 2.09], p = 0.043) and CM4 but not significant (HR [95% CI] 1.29 [0.91, 1.83], p = 0.15). Adjusted odds of more rapid control within 6 months were twofold higher for CM2 (p = 0.04) and CM4 (p = 0.055), respectively, versus CM1. CM2 did not differ from CM1. DM control was less likely for CM by telephone only than face-to-face in clinic. To benefit vulnerable patients with uncontrolled DM, in-person engagement may be required.

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Section: Discussionmentioning

confidence: 99%

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

et al. 2020

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“…However, their vulnerability was not explicitly identified.1All outcomes were disease-related. There was no discussion on the equity implication of these outcomes. 2 Nelson et al (2017)4The link between low income, ethnic/minority populations and high disease burden is clearly identified. However, this link is not theoretically driven and grounded as a guiding framework in the design of this study.3Health-related quality of life (HRQoL) and healthcare utilization are potentially equity-relevant, but it is not clearly established as such. 3 Lutes et al (2017)5Inequity/vulnerability of this study’s population is fully theorized (using a culturally-delivered Small Changes lifestyle approach) in their protocol publication.4Some outcomes were equity-relevant (self-reported empowerment, self-efficacy and self-care) and relevant to alleviating or redressing health inequities faced by the population of interest. 4 Kim et al (2016)4This family clearly defines the Korean American population’s vulnerability to diabetes, diabetes self-management and other sociocultural barriers.3Some outcomes relevant to health equity includes self-efficacy, diabetes-related quality of life, depression and self-care. 5 Palmas et al (2014)3Increased incidence of T2DM in Hispanic Americans relative to white population is recognized but is not clearly defined as an inequity.1All outcomes were disease-related.…”

Section: Resultsmentioning

confidence: 99%

Defining and measuring health equity in research on task shifting in high-income countries: A systematic review

Orkin

McArthur²,

Venugopal

et al. 2019

SSM - Population Health

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Introduction Task shifting interventions have been implemented to improve health and address health inequities. Little is known about how inequity and vulnerability are defined and measured in research on task shifting. We conducted a systematic review to identify how inequity and vulnerability are identified, defined and measured in task shifting research from high-income countries. Methods and analysis We implemented a novel search process to identify programs of research concerning task shifting interventions in high-income countries. We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and CENTRAL to identify articles published from 2004 to 2016. Each program of research incorporated a “parent” randomized trial and “child” publications or sub-studies arising from the same research group. Two investigators extracted (1) study details, (2) definitions and measures of health equity or population vulnerability, and (3) assessed the quality of the reporting and measurement of health equity and vulnerability using a five-point scale developed for this study. We summarized the findings using a narrative approach. Results Fifteen programs of research met inclusion criteria, involving 15 parent randomized trials and 62 child publications. Included programs of research were all undertaken in the United States, among Hispanic- (5/15), African- (2/15), and Korean-Americans (1/15), and low socioeconomic status (2/15), rural (2/15) and older adult populations (2/15). Task shifting interventions included community health workers, peers, and a variety of other non-professional and lay workers to address a range of non-communicable diseases. Some research provided robust analyses of the affected populations’ health inequities and demonstrated how a task shifting intervention redressed those concerns. Other studies provided no such definitions and measured only biomedical endpoints. Conclusion Included studies vary substantially in the definition and measurement of health inequity and vulnerability. A more precise theoretical and evaluative framework for task shifting is recommended to effectively achieve the goal of equitable health.

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“…Because of the barriers from poverty and poor living environment, health care interventions, even those that venture beyond the clinic to the home and community, might be inadequate without additional commitments addressing social factors, such as housing and safer neighborhoods. 20.09 (20.24 to 0.06) *CIs are based on percentile bounds from 999 bootstrap replications, with resampling at the patient level stratified by intervention group. In a few instances, bootstrap replication could not produce an estimate.…”

Section: Discussionmentioning

confidence: 99%

Home visits for uncontrolled asthma among low-income adults with patient portal access

Apter

Localio

Morales

et al. 2019

Journal of Allergy and Clinical Immunology

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Background: Asthma disproportionately affects low-income and minority adults. In an era of electronic records and Internetbased digital devices, it is unknown whether portals for patientprovider communication can improve asthma outcomes. Objective: We sought to estimate the effect on asthma outcomes of an intervention using home visits (HVs) by community health workers (CHWs) plus training in patient portals compared with usual care and portal training only. Methods: Three hundred one predominantly African American and Hispanic/Latino adults with uncontrolled asthma were recruited from primary care and asthma specialty practices serving low-income urban neighborhoods, directed to Internet access, and given portal training. Half were randomized to HVs over 6 months by CHWs to facilitate competency in portal use and promote care coordination. Results: One hundred seventy (56%) patients used the portal independently. Rates of portal activity did not differ between randomized groups. Asthma control and asthma-related quality of life improved in both groups over 1 year. Differences in improvements over time were greater for the HV group for all outcomes but reached conventional levels of statistical significance only for the yearly hospitalization rate (20.53; 95% CI, 21.08 to 20.024). Poor neighborhoods and living conditions plus limited Internet access were barriers for patients to complete the protocol and for CHWs to make HVs. Conclusion: For low-income adults with uncontrolled asthma, portal access and CHWs produced small incremental benefits. HVs with emphasis on self-management education might be necessary to facilitate patient-clinician communication and to improve asthma outcomes. (J Allergy Clin Immunol 2019;144:846-53.)

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Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010–2014

Cited by 29 publications

References 27 publications

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study

Defining and measuring health equity in research on task shifting in high-income countries: A systematic review

Home visits for uncontrolled asthma among low-income adults with patient portal access

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