Nelson Karin, Drain Nathan, Robinson June, Kapp Janet, Hebert Paul, Taylor Leslie, Silverman Julie, Kiefer Meghan, Lessler Dan, Krieger James
VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States; University of Washington, School of Public Health, United States.
Public Health - Seattle & King County, United States.
Contemp Clin Trials. 2014 Jul;38(2):361-9. doi: 10.1016/j.cct.2014.06.011. Epub 2014 Jun 21.
BACKGROUND & OBJECTIVES: Community health workers (CHWs) may be an important mechanism to provide diabetes self-management to disadvantaged populations. We describe the design and baseline results of a trial evaluating a home-based CHW intervention.
METHODS & RESEARCH DESIGN: Peer Support for Achieving Independence in Diabetes (Peer-AID) is a randomized, controlled trial evaluating a home-based CHW-delivered diabetes self-management intervention versus usual care. The study recruited participants from 3 health systems. Change in A1c measured at 12 months is the primary outcome. Changes in blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self-management behaviors at 12 months are secondary outcomes.
A total of 1438 patients were identified by a medical record review as potentially eligible, 445 patients were screened by telephone for eligibility and 287 were randomized. Groups were comparable at baseline on socio-demographic and clinical characteristics. All participants were low-income and were from diverse racial and ethnic backgrounds. The mean A1c was 8.9%, mean BMI was above the obese range, and non-adherence to diabetes medications was high. The cohort had high rates of co-morbid disease and low self-reported health status. Although one-third reported no health insurance, the mean number of visits to a physician in the past year was 5.7. Trial results are pending.
Peer-AID recruited and enrolled a diverse group of low income participants with poorly controlled type 2 diabetes and delivered a home-based diabetes self-management program. If effective, replication of the Peer-AID intervention in community based settings could contribute to improved control of diabetes in vulnerable populations.
社区卫生工作者(CHW)可能是为弱势群体提供糖尿病自我管理的重要机制。我们描述了一项评估家庭式CHW干预试验的设计及基线结果。
糖尿病独立同伴支持(Peer-AID)是一项随机对照试验,评估家庭式CHW提供的糖尿病自我管理干预与常规护理的效果。该研究从3个卫生系统招募参与者。12个月时测量的糖化血红蛋白(A1c)变化是主要结局。12个月时血压、血脂、医疗保健利用率、健康相关生活质量、自我效能感及糖尿病自我管理行为的变化是次要结局。
通过病历审查确定共有1438例患者可能符合条件,通过电话筛选了445例患者的资格,287例患者被随机分组。两组在基线时的社会人口统计学和临床特征具有可比性。所有参与者均为低收入,且来自不同种族和族裔背景。平均A1c为8.9%,平均体重指数(BMI)高于肥胖范围,糖尿病药物治疗的依从性较低。该队列共病率高,自我报告的健康状况较差。虽然三分之一的人报告没有医疗保险,但过去一年平均看医生次数为5.7次。试验结果尚未得出。
Peer-AID招募并纳入了一组多样化的2型糖尿病控制不佳的低收入参与者,并实施了家庭式糖尿病自我管理项目。如果有效,在社区环境中复制Peer-AID干预措施可能有助于改善弱势群体的糖尿病控制情况。