Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes

Carrasquillo, Olveen; Lebron, Cynthia; Alonzo, Yisel; Li, Hua; Chang, Aileen Y.; Kenya, Sonjia

doi:10.1001/jamainternmed.2017.0926

Cited by 52 publications

(81 citation statements)

References 27 publications

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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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“…Patients trust CHWs who understand their sociocultural barriers, provide social support, speak the same language, and can increase the relevancy of disease self‐management for individuals who are often struggling to manage competing priorities. Importantly, mounting evidence suggests that CHW involvement can contribute to improvement in diabetes self‐management as well as significant decreases in HbA1C that have ranged from 0.5–0.9% …”

mentioning

confidence: 99%

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

et al. 2017

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OBJECTIVES To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A 1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS Similar HbA1C declines were noted after receiving the 1 year of CHW support: À0.45% (95% confidence interval [CI] À0.96 to 0.05) with CHW versus À0.42% (95% CI À0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI À1.92 to 3.53) with CHW versus À1.85 mm Hg (95% CI À4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.

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“…In a prior diabetes study, we experienced 21% attrition [21]. As figure 1 shows, even with such attrition, we would have > 80% power to detect an SBP difference of 8mmHg.…”

Section: Discussion Limitationsmentioning

confidence: 96%

“…While more limited, randomized studies have also shown CHW interventions can improved physiological outcomes such as glycemic control [21].…”

Section: Prior Workmentioning

confidence: 99%