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同伴支持促进糖尿病患者实现独立(同伴援助):社区卫生工作者协助糖尿病自我管理支持的随机对照试验的设计、方法和基线特征

Peer Support for Achieving Independence in Diabetes (Peer-AID): design, methods and baseline characteristics of a randomized controlled trial of community health worker assisted diabetes self-management support.

作者信息

Nelson Karin, Drain Nathan, Robinson June, Kapp Janet, Hebert Paul, Taylor Leslie, Silverman Julie, Kiefer Meghan, Lessler Dan, Krieger James

机构信息

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.

出版信息

Contemp Clin Trials. 2014 Jul;38(2):361-9. doi: 10.1016/j.cct.2014.06.011. Epub 2014 Jun 21.

Abstract

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景与目的

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。

方法与研究设计

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。

结果

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。

结论

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。

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