Community to clinic navigation to improve diabetes outcomes

Abstract

Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes

“…Limitations of our study include higher mean baseline PAM scores compared to similar intervention studies in rural areas (Safford et al, 2015;Schoenberg et al, 2017). Furthermore, more than 75% of the sample was at PAM Level 3 or higher at baseline.…”

“…Engagement, defined as the active partnership between patients and health care professionals, is necessary for improved health outcomes (Carman et al, 2013). However, scant research has validated the relationship between the level of engagement in diabetes care and health outcomes, especially among rural and minority populations (Schoenberg, Ciciurkaite, & Greenwood, 2017).…”

Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settings

“…Nineteen studies occurred in a clinic, of which 13 were community-based *. There were 4 federally qualified health centers, 40,45,59,64 1 patient-centered medical home, 48 and 5 primary care centers, 36,43,53,56,57 one of which was a cancer treatment center. 57 In addition, 1 study was set in a joint cancer treatment facility and research center.…”

The mediating/moderating role of cultural context factors on self-care practices among those living with diabetes in rural Appalachia

“…Within the US rural population, nearly one in five (17%) adults in rural Appalachia have been diagnosed with T2DM [ 2 ]. Rural Appalachians are disproportionately likely to experience factors that predispose them to the development of T2DM, such as higher levels of stress, obesity, food insecurity, as well as low levels of health literacy and limited access to health services [ 3 , 4 ]. In addition to these predisposing factors, rural dwellers are exposed to challenging social-environment factors, including high rates of poverty and sparse community and medical services, that may complicate the management of T2DM.…”