Mehta Priya P, Santiago-Torres Juan E, Wisely C Ellis, Hartmann Katherine, Makadia Frini A, Welker Mary Jo, Habash Diane L
From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
J Am Board Fam Med. 2016 May-Jun;29(3):318-24. doi: 10.3122/jabfm.2016.03.150256.
There are a number of well-established barriers to accessing primary care. The LINKED Study set out to improve primary care usage through 1-on-1 counseling and referrals for patients with diabetes being treated at local free clinics. We hypothesized that this educational intervention paired with expedited referral would increase the use of federally qualified health centers (FQHCs) as a source of health care and ultimately lead to improved diabetic health.
Medical student volunteers counseled participants on the importance of primary care. The participants then completed surveys about diabetic health, socioeconomic status, and general demographics. Participants were subsequently assigned to 1 of 2 FQHCs; designated care coordinators facilitated appointments. At the end of a 9-month action period, participants repeated the initial surveys, now including appointment history and health data (hemoglobin A1c (%) [HbA1c], body mass index).
Sixty-eight participants were enrolled. The average time since a diagnosis of diabetes mellitus was 8.3 years (standard deviation [SD], 8.4 years), and 25% of participants used insulin. Mean baseline HbA1c for participants with a recorded value (n = 55) was 9.5 (SD, 2.5). FQHC appointments were scheduled by 68% of participants; 38% of the participants attended ≥2 appointments. The most common reported barriers to accessing primary care were no prior health insurance (85.3%) and cost of medical care (72.1%). In our follow-up assessment there was a statistically significant decrease in HbA1c for those linked to FQHCs (9.5 [SD, 2.3] to 8.3 [SD, 2.2]; n = 21).
This study demonstrates the utility of a linkage program from free clinics to FQHCs. Those individuals with diabetes receiving health care from an FQHC demonstrated improved glycemic control.
获得初级保健存在许多既定的障碍。“联系研究”旨在通过为在当地免费诊所接受治疗的糖尿病患者提供一对一咨询和转诊服务，来提高初级保健的利用率。我们假设这种教育干预与加速转诊相结合，会增加将联邦合格医疗中心（FQHCs）作为医疗保健来源的使用，并最终改善糖尿病患者的健康状况。
医学生志愿者就初级保健的重要性对参与者进行咨询。参与者随后完成了关于糖尿病健康状况、社会经济地位和一般人口统计学的调查。参与者随后被分配到两家FQHC中的一家；指定的护理协调员协助安排预约。在为期9个月的行动期结束时，参与者重复了最初的调查，现在包括预约历史和健康数据（糖化血红蛋白（%）[HbA1c]、体重指数）。
招募了68名参与者。自诊断糖尿病以来的平均时间为8.3年（标准差[SD]，8.4年），25%的参与者使用胰岛素。有记录值的参与者（n = 55）的平均基线HbA1c为9.5（SD，2.5）。68%的参与者安排了FQHC预约；38%的参与者参加了≥2次预约。报告的获得初级保健最常见障碍是以前没有医疗保险（85.3%）和医疗费用（72.1%）。在我们的随访评估中，与FQHCs建立联系的参与者的HbA1c有统计学意义的下降（从9.5 [SD，2.3]降至8.3 [SD，2.2]；n = 21）。
本研究证明了从免费诊所到FQHCs的联系项目的效用。那些从FQHCs接受医疗保健的糖尿病患者血糖控制得到改善。
