Collinsworth Ashley, Vulimiri Madhulika, Snead Christine, Walton James
Baylor Scott & White Health, Dallas, TX, USA
University of North Carolina, Chapel Hill, NC, USA.
Health Promot Pract. 2014 Nov;15(2 Suppl):51S-61S. doi: 10.1177/1524839914539961.
New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.
需要新的、全面的慢性病管理方法，以确保患者，尤其是那些更有可能经历健康差距的患者，能够获得预防和控制糖尿病所需的临床护理、自我管理资源以及支持。社区卫生工作者（CHWs）一直在社区环境中工作以减少医疗保健差距，目前正在一些临床环境中部署，作为改善医疗服务可及性和质量的一种手段。在慢性病护理模式的指导下，贝勒医疗保健系统将社区卫生工作者纳入社区诊所的临床团队，目标是减少在糖尿病护理和治疗结果方面观察到的差距。本研究调查了对患者、社区卫生工作者和初级保健提供者（PCPs）的访谈结果，以了解医疗保健提供系统如何重新设计以有效纳入社区卫生工作者，以及将社区卫生工作者纳入初级保健团队如何培养有见识、积极主动的患者以及有准备、积极主动的医疗团队，他们能够共同努力以实现改善患者治疗结果。受访者表示，初级保健提供者继续提供临床检查并管理患者护理，但糖尿病教育、营养咨询和患者激活的角色转移到了社区卫生工作者身上。社区卫生工作者还为患者提供社会支持以及与社区资源的联系。将社区卫生工作者纳入临床护理团队提高了患者的知识水平和激活程度、初级保健提供者识别并主动满足特定患者需求的能力以及患者治疗结果。
