Ell Kathleen, Aranda María P, Wu Shinyi, Oh Hyunsung, Lee Pey-Jiuan, Guterman Jeffrey
USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.
USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States; USC Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.
Contemp Clin Trials. 2017 Oct;61:1-9. doi: 10.1016/j.cct.2017.07.001. Epub 2017 Jul 3.
The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score≥10) were enrolled, randomized to AHH (n=178) or UC (n=170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12months was 30% (AHH 31%, UC 28%, P=0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.
在洛杉矶县卫生服务部（LAC - DHS）社区诊所进行的一项为期12个月的随机试验中，研究评估了糖尿病和/或心脏病患者的抑郁状况及自我护理管理情况。我们比较了LAC - DHS诊所的常规护理（UC）与“援手相助”（AHH）干预措施，在该干预措施中，由研究项目雇佣并监督的双语健康促进员提供每周6次的心理教育课程，之后还有强化课程。在1957名接受筛查的患者中，348名抑郁患者（PHQ - 9评分≥10）被纳入研究，在进行了评估心理健康、治疗接受情况、共病疾病、自我护理管理和环境压力源的基线访谈后，随机分为AHH组（n = 178）或UC组（n = 170）。由对研究组不知情的独立访谈者在6个月和12个月时重复进行综合评估。患者主要为女性（85%）、拉丁裔（99%）、在美国境外出生（91%），其中85%患有糖尿病，4%患有心脏病，11%两者皆有。12个月时的研究失访率为30%（AHH组31%，UC组28%，P = 0.51）。没有基线特征与失访相关。AHH组一半的患者接受了4次或更多课程。意向性分析发现，研究组在6个月和12个月时没有显著差异。前后配对t检验显示，每组的大多数指标都有显著改善。在试验期间，LAC - DHS启动了包括抑郁筛查在内的医疗保健改进措施，将患者转介给包括社区卫生工作者（与健康促进员角色相同）在内的诊所工作人员，以改善患者护理管理。两个患者组表现同样良好，这可能是强化医疗保健模式的作用。未来的研究应该在其他具有类似共病情况的群体和护理环境中复制这种整合了健康促进员的护理模式。
