Nurse-Community Health Worker Team Improves Diabetes Care in American Samoa Results of a randomized controlled trial
Nurse-Community Health Worker Team Improves Diabetes Care in American Samoa Results of a randomized controlled trial
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DOI：
10.2337/dc12-1969
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发表时间：
2013-07-01
期刊：
影响因子：
16.2
通讯作者：
McGarvey, Stephen T.
中科院分区：
文献类型：
--
作者：
DePue, Judith D.;Dunsiger, Shira;McGarvey, Stephen T.
评估文化适应的有效性，初级保健为基础的护士社区卫生工作者（CHW）团队干预，以支持糖尿病自我管理的糖尿病控制和其他biologicalmeasure.Research设计和方法，二百六十八名萨摩亚参与者与2型糖尿病被招募从社区卫生中心在美属萨摩亚和随机分配的村庄集群的护士-CHW团队干预组或接受常规护理的等待名单对照组。CHWTS-参与者的平均年龄为55岁，62%为女性，平均受教育年限为12.5年，41%有工作，基线时平均HbA（1c）为9.8%。12个月时，调整混杂因素后，CHW参与者的平均HbA（1c）显著低于常规治疗（B = -0.53; SE = 0.21; P = 0.03）。在控制混杂因素后，CHW组HbA（1c）临床显著改善至少0.5%的几率是常规治疗组的两倍（P = 0.05）。有血压，体重，或腰围在12个月groups.CONCLUSIONS-A文化适应护士CHW团队干预没有显着差异，能够显着改善糖尿病控制在美国领土的美属萨摩亚。这是将循证模式转化为高风险人群和资源匮乏环境的重要举措。
OBJECTIVE-To evaluate the effectiveness of a culturally adapted, primary care based nurse community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.RESEARCH DESIGN AND METHODS-Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.RESULTS-Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA(1c) was 9.8% at baseline. At 12 months, mean HbA(1c) was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = -0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA(1c) of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.CONCLUSIONS-A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.