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Title: Integrating CHWs as part of the team leading diabetes group visits: A randomized controlled feasibility study

Author
item VAUGHAN, ELIZABETH - Baylor College Of Medicine
item JOHNSTON, CRAIG - University Of Houston
item CARDENAS, VICTOR - University Of Texas Medical Branch
item MORENO, JENNETTE - Children'S Nutrition Research Center (CNRC)
item FOREYT, JOHN - Baylor College Of Medicine

Submitted to: The Diabetes Educator
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/15/2017
Publication Date: 12/1/2017
Citation: Vaughan, E.M., Johnston, C.A., Cardenas, V.J., Moreno, J.P., Foreyt, J.P. 2017. Integrating CHWs as part of the team leading diabetes group visits: A randomized controlled feasibility study. The Diabetes Educator. 43(6):589-599. http://dx.doi.org/10.1177/0145721717737742.

Interpretive Summary: Hispanic adults have a 66% greater risk of developing diabetes and a 50% increased mortality rate compare to non-Hispanic whites. Rates of poverty and poorer access to healthcare are also key concerns amongst this population. In this study we investigated the feasibility of integrating Community Health Workers (CHWs) as part of the team leading a comprehensive diabetes group visit program as a creative approach to provide more intensive management for diabetes in a community clinic serving low-income Hispanics than is typically possible using traditional models of diabetes management. CHWs are non-health care professionals who are typically members of the targeted community or who demonstrate connectedness with the target community and demonstrate an interest in helping underserved individuals. In the current study, these individuals were trained and certified as CHWs. CHWs helped to facilitate monthly comprehensive diabetes group visits and contacted participants each week in-between the group visits. This weekly contact focused on reinforcing treatment goals such as weight loss, medication adherence, and reminding patients about upcoming appointments. Participants in the intervention group had better clinical outcomes in terms of maintenance of blood sugar levels and were more likely to obtain important diabetes care such as eye exams, diabetes foot exams, and mammograms consistent with standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association. Participants also found this to be a highly acceptable intervention. Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system level approach to improve glycemic control and achieve guideline concordance among low-income Hispanic individuals.

Technical Abstract: The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n=50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system level intervention to improve glycemic control and achieve guideline concordance.