Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review.
Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review.
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DOI：
10.2105/ajph.2015.302987
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发表时间：
2016-04
影响因子：
12.7
通讯作者：
Han HR
中科院分区：
文献类型：
--
作者：
Kim K;Choi JS;Choi E;Nieman CL;Joo JH;Lin FR;Gitlin LN;Han HR
社区卫生工作者（CBHWs）是一线公共卫生工作者，他们是他们所服务的社区值得信赖的成员。最近，相当多的注意力已经提请CBHWs在促进健康行为和健康的结果往往面临健康不平等的弱势群体。该系统性综述综合了有关CBHW干预措施类型、CBHW的资格和特征以及此类干预措施在慢性非传染性疾病弱势人群中的患者结局和成本效益的证据。对PubMed、Embase、Cumulative Index to Nursing and Allied Health Literature（CINAHL）和科克伦（Cochrane）等4个电子数据库进行了检索，并对参考文献进行了手动检索，以识别2014年8月之前以英文发表的随机对照试验。最初共筛选了934篇唯一引文的标题和摘要。然后，两名评审员独立评估了166篇全文文章，这些文章被传递到评审过程中。61项研究和6篇伴随文章（例如，成本效益分析）符合入选资格标准。由4名经过培训的研究助理（RA）使用作者开发的标准化数据提取表提取数据。随后，独立RA审查了提取的数据以检查准确性。通过研究团队成员之间的讨论解决分歧。由提取相关研究信息的两名RA评价每项研究的质量。评分者间一致率范围为61%至91%（平均86%）。质量评级方面的任何差异均通过团队讨论解决。除4项研究外，所有研究均在美国进行。CBHW干预的两个最常见领域是癌症预防（n=30）和心血管疾病风险降低（n=26）。CBHWs承担的角色包括：健康教育（n=48），咨询（n=36），导航辅助（n=21），病例管理（n=4），社会服务（n=7）和社会支持（n=18）。53项研究提供了关于CBHW培训的信息，但CBHW能力评价（n=9）和监督程序（n=24）在很大程度上被低估。CBHW培训的时长和持续时间范围为4小时至240小时，在24项报告培训时长的研究中，平均为41.3小时（中位数：16.5小时）。8项研究报告了监督的频率，从每周到每月不等。癌症预防（n=21）和心血管风险降低（n=16）有改善的趋势。八篇文章记录了成本效益分析，发现将CBHW整合到医疗保健服务系统中与成本效益和可持续护理相关。CBHW干预措施似乎是有效的替代品相比，也具有成本效益的某些健康状况，特别是当与低收入，服务不足，种族和少数民族社区合作。未来的研究有必要将CBHWs完全纳入医疗保健系统，以促进弱势群体的非传染性健康结果。
Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. This systematic review synthesized evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost effectiveness of such interventions in vulnerable populations with chronic, non-communicable conditions. Four electronic database searches, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, and hand searches of reference collections were undertaken to identify randomized controlled trials published in English before August 2014. A total of 934 unique citations were screened initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and six companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Data were extracted by 4 trained research assistants (RA) using a standardized data extraction form developed by the authors. Subsequently, an independent RA reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by two RAs who extracted relevant study information. Inter-rater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. All but 4 studies were conducted in the U.S. The two most common areas for CBHW interventions were cancer prevention (n=30) and cardiovascular disease risk reduction (n=26). The roles assumed by CBHWs included: health education (n=48), counseling (n=36), navigation assistance (n=21), case management (n=4), social services (n=7), and social support (n=18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n=9) and supervision procedures (n=24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n=21) and cardiovascular risk reduction (n=16). Eight articles documented cost effective analysis and found that integrating CBHWs into the healthcare delivery system was associated with cost-effective and sustainable care. CBHW interventions appear to be effective when compared to alternatives and also cost-effective for certain health conditions particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote non-communicable health outcomes among vulnerable populations.