同伴健康教练在改善低收入糖尿病患者血糖控制方面的效果：一项随机对照试验方案。
The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial.
机构信息
Department of Family and Community Medicine, University of California, San Francisco (UCSF), 995 Potrero Ave, Building 80/83, San Francisco, CA 94110, USA.
出版信息
BMC Public Health. 2011 Apr 1;11:208. doi: 10.1186/1471-2458-11-208.
BACKGROUND
Although self-management support improves diabetes outcomes, it is not consistently provided in health care settings strained for time and resources. One proposed solution to personnel and funding shortages is to utilize peer coaches, patients trained to provide diabetes education and support to other patients. Coaches share similar experiences about living with diabetes and are able to reach patients within and beyond the health care setting. Given the limited body of evidence that demonstrates peer coaching significantly improves chronic disease care, this present study examines the impact of peer coaching delivered in a primary care setting on diabetes outcomes.
METHODS/DESIGN: The aim of this multicenter, randomized control trial is to evaluate the effectiveness of utilizing peer coaches to improve clinical outcomes and self-management skills in low-income patients with poorly controlled diabetes. A total of 400 patients from six primary health centers based in San Francisco that serve primarily low-income populations will be randomized to receive peer coaching (n = 200) or usual care (n = 200) over 6 months. Patients in the peer coach group receive coaching from patients with diabetes who are trained and mentored as peer coaches. The primary outcome is change in HbA1c. Secondary outcomes include change in: systolic blood pressure, body mass index (BMI), LDL cholesterol, diabetes self-care activities, medication adherence, diabetes-related quality of life, diabetes self-efficacy, and depression. Clinical values (HbA1c, LDL cholesterol and blood pressure) and self-reported diabetes self-efficacy and self-care activities are measured at baseline and after 6 months for patients and coaches. Peer coaches are also assessed at 12 months.
DISCUSSION
Patients with diabetes, who are trained as peer health coaches, are uniquely poised to provide diabetes self management support and education to patients. This study is designed to investigate the impact of peer health coaching in patients with poorly controlled diabetes. Additionally, we will assess disease outcomes in patients with well controlled diabetes who are trained and work as peer health coaches.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT01040806.
背景
尽管自我管理支持可以改善糖尿病的治疗效果，但在时间和资源紧张的医疗环境中，这种支持并不能持续提供。为了解决人员和资金短缺的问题，一种解决方案是利用同伴教练，即经过培训向其他患者提供糖尿病教育和支持的患者。教练与其他患者有着相似的糖尿病生活经历，并能够在医疗保健环境内外接触到患者。鉴于仅有有限的证据表明同伴教练可以显著改善慢性病的护理，本研究旨在检查在初级保健环境中实施同伴教练对糖尿病治疗结果的影响。
方法/设计：这项多中心、随机对照试验的目的是评估利用同伴教练来改善临床结果和自我管理技能的有效性，对象是来自旧金山 6 家初级保健中心的低收入、糖尿病控制不佳的患者。这 6 家初级保健中心主要服务于低收入人群，共有 400 名患者参与，他们将被随机分为接受同伴教练（n=200）或常规护理（n=200）组，为期 6 个月。同伴教练组的患者将接受经过培训和指导的糖尿病患者的教练服务。主要结果是糖化血红蛋白（HbA1c）的变化。次要结果包括：收缩压、体重指数（BMI）、低密度脂蛋白胆固醇、糖尿病自我护理活动、药物依从性、糖尿病相关生活质量、糖尿病自我效能和抑郁的变化。基线时和 6 个月后，将对患者和教练进行临床值（HbA1c、LDL 胆固醇和血压）和自我报告的糖尿病自我效能和自我护理活动的测量。同伴教练还将在 12 个月时进行评估。
讨论
经过培训的同伴健康教练可以为患者提供独特的糖尿病自我管理支持和教育。本研究旨在调查同伴健康教练对控制不佳的糖尿病患者的影响。此外，我们还将评估经过培训并担任同伴健康教练的控制良好的糖尿病患者的疾病结果。
试验注册
ClinicalTrials.gov 标识符：NCT01040806。
Zotero 插件