Community Health Workers Versus Nurses as Counselors or Case Managers in a Self-Help Diabetes Management Program

Kim, Kim B.; Kim, Miyong T.; Lee, Ho-Chang; Nguyen, Tam H.; Bone, Lee R.; Levine, David M.

doi:10.2105/ajph.2016.303054

Cited by 26 publications

(30 citation statements)

References 28 publications

(29 reference statements)

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“…[3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration.…”

Section: Introductionmentioning

confidence: 99%

Integrating Community Health Workers Into Medical Homes

Rogers

Manser

Cleary³

et al. 2018

Ann Fam Med

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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. METHODSWe 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. 2018;16:14-20. https://doi.org/10.1370/afm.2171. Ann Fam Med INTRODUCTIONC ommunity health workers (CHWs), trusted frontline health workers who have a close understanding of the community served, 1 can be valuable contributors to the team-based and patient-centered care promoted through the patient-centered medical home (PCMH) model. 2 CHWs complement roles played by traditional health professionals through culturally sensitive outreach, patient education, resource identification, case management, care coordination, and patient support. [3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration. [24][25][26] Researchers have explored the experience of ...

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Section: Introductionmentioning

confidence: 99%

Integrating Community Health Workers Into Medical Homes

Rogers

Manser

Cleary³

et al. 2018

Ann Fam Med

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“…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. There was no discussion on the equity implication of these outcomes. 6 Rothschild et al (2014)4Study describes burden of disease in target population, and implicitly theorizes that relationship as related to cultural, linguistic and educational barriers.3Self-efficacy may be relevant to alleviating health effects of PROGRESS-Plus variables, but this is not explicitly characterized in the study. 7 Tang et al (2014)2This study was undertaken in a low-income, Latino population.…”

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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“…Our findings show increased treatment engagement among patients receiving Gla-300 who enrolled in a support program with a telephone-based component designed to meet individual needs. Improvements in patient self-management and knowledge of the disease, glycemic control, and quality of life were previously reported for community-based support programs targeting different ethnicities and socioeconomic groups, as well as for individualized and culturally appropriate telephone-based interventions involving case management by nurse practitioners [ 17 – 20 ]. Moreover, it has been observed that coaching interventions do not necessarily need to be administered by live coaches or by health-care professionals involved in the treatment of diabetes to result in meaningful improvements in glycemic levels.…”

Section: Discussionmentioning

confidence: 95%

Improved Treatment Engagement Among Patients with Diabetes Treated with Insulin Glargine 300 U/mL Who Participated in the COACH Support Program

Goldman

Gill

Horn³

et al. 2018

Diabetes Ther

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IntroductionPersistence with basal insulin therapy can be suboptimal, despite recent improvements in insulin formulations and delivery systems. Patient support programs may help increase adherence. This study evaluated the impact of the Toujeo® COACH support program, which provides patients with continuing and individualized education and advice on lifestyle changes, by assessing its effect on number of refills and days on therapy.MethodsThe study population included 1724 patients with diabetes who filled a first prescription for insulin glargine 300 U/mL (Gla-300) between April and December 2015 and received a welcome call from a Guide, and 1724 matched control patients from the Symphony Health Integrated Dataverse® prescription claims database. Control patients received Gla-300 but did not enroll in the program. These patients were matched based on age, gender, location, prior use of insulin, insulin dose, number of concomitant drugs, and copay tier.ResultsThe COACH and control groups comprised 52% men and 48% women; 22% were aged 18–47 years, 23% were 48–55 years, 27% 56–61 years, and 28% ≥ 62 years. Most (99%) had used insulin in the year before receiving the welcome call. At 6 months, patients in the COACH group had refilled their prescription 3.2 times on average, compared with 2.4 times for control patients (P < 0.0001); at 9 months, the average number of refills was 4.7 and 3.6, respectively (P < 0.0001). The average number of days on therapy at 6 months was 102.2 days in the COACH group and 81.5 days in the control group (P < 0.0001); at 9 months, the average number of days on therapy was 151.9 and 121.6, respectively (P < 0.0001).ConclusionPatients in the COACH program were significantly more likely to refill their prescriptions and stay on therapy. Patient support programs such as the COACH program could be an effective way to help improve diabetes care.FundingSanofi US, Inc. and McKesson Corporation.

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Community Health Workers Versus Nurses as Counselors or Case Managers in a Self-Help Diabetes Management Program

Cited by 26 publications

References 28 publications

Integrating Community Health Workers Into Medical Homes

Integrating Community Health Workers Into Medical Homes

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

Improved Treatment Engagement Among Patients with Diabetes Treated with Insulin Glargine 300 U/mL Who Participated in the COACH Support Program

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