Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
BMJ Open Diabetes Res Care. 2021 Aug;9(1). doi: 10.1136/bmjdrc-2021-002320.
Community clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the elehealth-supported, ntegrated Community Health Workers (CHWs), edication-access, group visit ducation (TIME) program in a community clinic.
Participants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.
Phase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: -0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (p<0.001-0.002). Phase II: participants had significant reductions in HbA1c (mean change: -0.78%, p=0.006), diastolic blood pressure (p=0.004), body mass index (0.012), weight (p=0.010), medication non-adherence (p<0.001), and six ADA measures (p=0.007-0.005). Phase I intervention versus phase II outcomes were comparable. CHWs improved knowledge from pre-test to post-tests (p<0.001).
A novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.
社区诊所常常面临实际障碍，阻碍了研究试验结果的启动和复制。指导是克服这些障碍的一种潜在策略。我们试行一种面对面和远程医疗指导策略，在社区诊所实施支持电子健康的综合社区卫生工作者（CHW）、药物获取、小组访问教育（TIME）计划。
参与者（n=55）为 2 型糖尿病的低收入拉丁裔（a）人。研究分两个 6 个月的阶段进行。第一阶段为诊所团队提供概念验证和观察经验；参与者（n=37）随机分为干预组（TIME）或对照组（常规护理），研究团队在诊所团队观察的同时开展 TIME。第二阶段提供指导以实施 TIME，研究团队指导诊所团队对新的无先前暴露于该计划的单一臂队列的参与者（n=18）进行 TIME。分析包括糖尿病结局的基线至 6 个月比较（主要结局：血红蛋白 A1c（HbA1c））：第一阶段干预与对照组、第二阶段（组内）和研究运行（第一阶段干预）与诊所运行（第二阶段）手臂。我们还评估了基线至 6 个月 CHW 知识变化。
第一阶段：与对照组相比，干预组参与者的基线至 6 个月的 HbA1c（平均变化：干预组：-0.73%，对照组：0.08%，p=0.016）、体重（p=0.044）、目标 HbA1c（p=0.035）、低血糖（p=0.021）、药物不依从（p=0.0003）和六个美国糖尿病协会（ADA）指标中的五个（p<0.001-0.002）均有显著改善。第二阶段：参与者的 HbA1c（平均变化：-0.78%，p=0.006）、舒张压（p=0.004）、体重指数（0.012）、体重（p=0.010）、药物不依从（p<0.001）和六个 ADA 指标（p=0.007-0.005）均有显著降低。第一阶段干预与第二阶段结果相当。CHW 的知识从预测试到后测试都有所提高（p<0.001）。
一种新颖的、有指导的方法将 TIME 引入社区诊所，改善了糖尿病结局。需要进行更长时间的更大规模研究，以充分评估指导社区诊所的潜力。
