Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Ethn Dis. 2021 Jan 21;31(1):47-56. doi: 10.18865/ed.31.1.47. eCollection 2021 Winter.
The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hypertension disparities by addressing patients' social determinants of health. We sought to identify which social determinants of health are associated with a patient's likelihood of engaging with collaborative care team members and with the nurse care manager's likelihood of enlisting community health workers (CHW) to provide additional support to patients.
We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social determinants of health, reported on the study's baseline survey, were associated with the odds of patients engaging with the collaborative care intervention, and of nurses deploying community health workers.
Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likelihood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those reporting higher numeracy had lower odds of receiving a CHW referral.
IMPLICATIONS/CONCLUSIONS: A patient's social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers.
协作护理团队由护理经理和社区卫生工作者组成，已成为解决高血压差异的有前途的策略，通过解决患者健康的社会决定因素。我们试图确定哪些健康的社会决定因素与患者参与协作护理团队成员的可能性以及护理经理招募社区卫生工作者（CHW）为患者提供额外支持的可能性相关。
我们对接受协作护理干预的患者进行了群组内纵向分析，该研究是一项实用的、集群随机试验，旨在减少高血压控制方面的差异（N=888）。使用广义估计方程来确定在研究基线调查中报告的哪些健康的社会决定因素与患者参与协作护理干预以及护士部署社区卫生工作者的可能性相关。
无法工作的患者和健康素养较高的患者与全职工作或健康素养较低的患者相比，参与协作护理团队的可能性较小。如果患者报告更高的健康素养、感知压力或粮食不安全，他们更有可能被其护理经理转介给社区卫生工作者，而报告更高的计算能力的患者接受 CHW 转介的可能性较低。
患者的健康的社会决定因素影响其参与协作护理干预的程度以及护理经理对社区卫生工作者提供补充支持的需求评估。
