Community Health Workers in Primary Care Practice

Abstract

New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

Service innovation from the edges: enhanced by telemedicine decision support

“…Continuous monitoring of blood sugar and correct treatment are of great importance to slow down the progression of the disease and subsequent complications. The traditional treatment offered by the general practitioners (GPs) has, however, not been sufficient, and a great number of patients have not reached the set treatment goals [3]. This has led to more complications in the population and has thus increased the number of patients referred to specialist health care.…”

“…Efficient treatment needs to be available before complications develop, and in line with national guidelines [4]. This is generally not the case in Norway, or elsewhere [3], as international studies demonstrate a need for improved care for diabetes patients [5][6][7].…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…A case study found that integrating CHWs into PCMHs is a means of providing support and education to hundreds of patients. 94 Furthermore, in the USA, Collinsworth et al 83 found that these workers improved patient knowledge and activation levels, primary care providers' ability to identify and address specific patient needs, and patient outcomes. Preventative care improved if a MCP-like model of primary care enabled CHWs to undertake disease/illness education, nutritional counselling, patient follow-up; to identify patient barriers to care or self-care, patient activation, social and self-management support (e.g.…”

“…87 MDTs are also part of the health-care delivery system redesign and connection to the community care resources involved in the CCM. 83 A study of focus groups with 387 people from 10 US communities suggested that having non-medical staff in boundary-spanning roles helped to co-ordinate patients' care and to address barriers to care co-ordination. Patients appreciated having individual care plans with a holistic orientation, including a personal physician providing access to continuous comprehensive care.…”

“…82 Community health workers (CHWs) recruited from the local population were used (in Texas) to help bridge gaps between patients and organisations, and between organisations, to enable PHC teams to connect patients with resources that patients need. 83 In New York, social workers were 'embedded' in PCPs and included in all practice-based meetings and other aspects of patient care. ACO quality metrics meetings were critical to developing working relationships with PCPs and other members of the care team, and with care co-ordination staff in other programmes.…”