Department of Ambulatory and Preventive Medicine, Alameda County Medical Center, 1411 East 31st St, Oakland, CA, 94602, USA.
J Gen Intern Med. 2013 Jul;28(7):938-42. doi: 10.1007/s11606-013-2367-7. Epub 2013 Feb 13.
Peer health coaching is an effective method of enhancing self-management support in patients with diabetes. It is unclear whether peer health coaching is equally beneficial to all patients with poor glycemic control, or is most effective for subgroups of patients.
To examine whether the effect of peer health coaching on hemoglobin A1c (A1c) is modified by characteristics that are known to be associated with diabetes control.
Sub-group analyses of randomized control trial.
Two hundred and ninety nine patients with diabetes receiving care in public health clinics who participated in a randomized controlled trial of peer health coaches.
We examined whether the association between study group and change in A1c was modified by differences in patients' demographic, behavioral or psychosocial characteristics. Analyses were adjusted for co-variables associated with change in A1c.
The effect of coaching on patient A1c was modified by patients' level of self-management and degree of medication adherence as baseline (p=.02, and p=.03 respectively in adjusted models). For participants with "low" self-management (one standard deviation below the mean score), the usual care group experienced a slight increase in A1c (0.3 %), while the health coaching group experienced a decrease (-0.9 %). For participants with "high" self-management (one standard deviation above the mean score), both groups experienced a similar decrease in A1c (usual care group: -1.0 %; health coaching group: -1.1 %). Participants with "low" medication adherence in the usual care group experienced an increase in A1c (0.5 %), while the health coaching group experienced a decrease (-0.8 %). Participants with "high" medication adherence experienced similar decreases (usual care group: -1.1 %; health coaching group: -1.3 %).
Peer health coaching had a larger effect on lowering A1c in patients with low levels of medication adherence and self-management support than in patients with higher levels. Peer health coaching interventions may be most effective if targeted to high-risk patients with diabetes with poor glycemic control and with poor self-management and medication adherence.
同伴健康教练是增强糖尿病患者自我管理支持的有效方法。目前尚不清楚同伴健康教练对血糖控制不佳的所有患者是否同样有益，还是对某些患者亚组最有效。
研究同伴健康教练对血红蛋白 A1c（A1c）的影响是否受已知与糖尿病控制相关的特征的影响。
随机对照试验的亚组分析。
299 名在公共卫生诊所接受治疗的糖尿病患者，他们参加了一项针对同伴健康教练的随机对照试验。
我们研究了研究组与 A1c 变化之间的关联是否因患者的人口统计学、行为或心理社会特征的差异而改变。分析调整了与 A1c 变化相关的协变量。
教练对患者 A1c 的影响受患者自我管理水平和药物依从性程度的影响（调整后的模型中，基线时分别为 p=.02 和 p=.03）。对于“低”自我管理（平均得分以下一个标准差）的参与者，常规护理组 A1c 略有增加（0.3%），而健康教练组则有所下降（-0.9%）。对于“高”自我管理（平均得分以上一个标准差）的参与者，两组 A1c 均下降（常规护理组：-1.0%；健康教练组：-1.1%）。常规护理组中“低”药物依从性的参与者 A1c 升高（0.5%），而健康教练组则下降（-0.8%）。药物依从性高的参与者 A1c 下降幅度相似（常规护理组：-1.1%；健康教练组：-1.3%）。
与药物依从性和自我管理支持水平较高的患者相比，同伴健康教练对降低低水平药物依从性和自我管理支持的患者的 A1c 有更大的影响。如果针对血糖控制不佳且自我管理和药物依从性差的高危糖尿病患者实施同伴健康教练干预，可能会更有效。
