Otero-Sabogal Regina, Arretz Desiree, Siebold Sarah, Hallen Elissa, Lee Russell, Ketchel Alana, Li Judy, Newman Jeffrey
Institute for Health and Aging, University of California, San Francisco Institute for Health and Aging, 3333 California Street, Suite 340, San Francisco, CA 94143, USA.
Qual Prim Care. 2010;18(6):363-72.
The role of community health workers (CHWs) has expanded from outreach and education to working within a clinical team in a primary care setting.
To improve self-management among patients with type 2 diabetes incorporating CHWs as members of a clinical team.
A cohort of 114 patients with type 2 diabetes enrolled in 2007 participated in a teambased self-management intervention with followup in 2008. The study assessed whether significant changes occurred in clinical, patient satisfaction and activation measures after the intervention compared with baseline. The programme was located at St Luke's Health Care Center in San Francisco, California, in an ethnically diverse neighbourhood serving predominantly low-income Latino patients. Clinical outcomes measured included glycosylated haemoglobin (HbA1c), low-density lipoprotein (LDL), blood pressure and total cholesterol. A Patient Activation Measure (PAM) assessed self-management. Both provider and patient experiences with the programme were also assessed using a patient telephone satisfaction survey and provider focus group.
The majority of patients were Latino Spanish speaking women on public insurance. Thirty-one patients participated in a telephone satisfaction survey. Six providers participated in a focus group to assess satisfaction with care. HealthFirst had a positive impact, improving HbA1c among high-risk patients with type 2 diabetes (HbA1c≥ 9.0) and maintaining glycaemic control among patients with controlled glycaemic level at baseline (HbA1c<7.0). In addition, LDL, total cholesterol and self-management outcomes significantly improved. Ninety-seven percent of patients were satisfied with the CHWs' support. Overall, providers' comfort level in referring patients to CHWs was very high.
Physician-CHW partnership had a positive impact on patients' self-management skills and clinical outcomes. Patients and physicians also had higher satisfaction with overall care. With appropriate training, CHWs can collaborate as team members with primary care providers and with non-medical providers to improve the quality of care.
社区卫生工作者（CHWs）的角色已从外展和教育扩展到在基层医疗环境中的临床团队中工作。
将社区卫生工作者纳入临床团队，以改善2型糖尿病患者的自我管理。
2007年招募的114名2型糖尿病患者参加了基于团队的自我管理干预，并于2008年进行随访。该研究评估了干预后与基线相比，临床、患者满意度和自我管理指标是否发生了显著变化。该项目位于加利福尼亚州旧金山的圣卢克医疗中心，该社区种族多样，主要服务低收入的拉丁裔患者。测量的临床结果包括糖化血红蛋白（HbA1c）、低密度脂蛋白（LDL）、血压和总胆固醇。使用患者激活量表（PAM）评估自我管理情况。还通过患者电话满意度调查和提供者焦点小组评估了提供者和患者对该项目的体验。
大多数患者是讲西班牙语的拉丁裔女性，参加公共保险。31名患者参与了电话满意度调查。6名提供者参加了焦点小组以评估对护理的满意度。HealthFirst产生了积极影响，改善了2型糖尿病高危患者（HbA1c≥9.0）的HbA1c，并使基线血糖水平得到控制（HbA1c<7.0）的患者维持血糖控制。此外，LDL、总胆固醇和自我管理结果显著改善。97%的患者对社区卫生工作者的支持感到满意。总体而言，提供者将患者转介给社区卫生工作者的舒适度非常高。
医生与社区卫生工作者的合作对患者的自我管理技能和临床结果产生了积极影响。患者和医生对整体护理的满意度也更高。通过适当的培训，社区卫生工作者可以作为团队成员与基层医疗提供者和非医疗提供者合作，以提高护理质量。
