Evaluating the Impact of Telehealth-Based, Diabetes Medication Training for Community Health Workers on Glycemic Control.

BACKGROUND

Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes.

OBJECTIVE

To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes.

METHODS

We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1-6) and dosing, titration, and emergencies (TEST-2, months 7-12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers.

RESULTS

Participants' (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) ( = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 ( = 0.002), TEST-2: 10.3-17.3/19.0 ( = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training.

CONCLUSIONS

Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.