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

Abstract

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.

Influence of interaction between community health workers and adults with chronic diseases on risk mitigation through care coordination

“…In-person contacts between the client and the CHW thus appear to positively influence the client's ability to address health, social, and behavioral risk factors, in comparison to other forms of contact including phone calls, emails, text messages, and faxing. While other studies have found positive effects of CHW in-person engagement among vulnerable patients with specific chronic diseases, 17,34,41 this study suggests that the beneficial impacts of in-person engagement extend to broader measures of risk-reduction across multiple health-related indicators as well as specific chronic disease conditions.…”

Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia

“…Therefore, older patients or patients with difficulties in using technology may have been more affected by this forced change towards telehealth, as described elsewhere [28] , [29] . One study performed in uncontrolled diabetes mellitus patients in late 2020 showed that T2DM control was less likely to be achieved by telephone only compared to face-to-face visits and suggested that to benefit vulnerable patients with uncontrolled T2DM, in-person engagement may be required [30] . This is consistent with our results.…”

A Review of Community Health Worker Integration in Health Departments

“…The type of care that CHWs provide varies in effectiveness as well. For instance, in a pilot project for Texas’ Transformation and Quality Improvement Program, the Texas Department of Health and Human Services certified CHWs to work with patients with diabetes [ 37 ]. Blood sugar control was more rapid in patients who received in-person care from CHWs compared to patients who participated in telehealth with CHWs [ 37 ].…”