Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans
Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans
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DOI：
10.1016/s0091-7435(03)00040-9
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发表时间：
2003-07-01
影响因子：
5.1
通讯作者：
Brancati, FL
中科院分区：
文献类型：
--
作者：
Gary, TL;Bone, LR;Brancati, FL
背景非裔美国人患有糖尿病并发症的比例不成比例，但很少有研究关注如何改善该人群的糖尿病控制。也有很少或根本没有数据结合初级保健和社区为基础的干预方法。我们将186名患有2型糖尿病的城市非洲裔美国人（76%为女性，平均年龄59埃9岁）随机分配到4个平行组中的1个：（1）仅常规护理;（2）常规护理+护士病例管理员（NCM）;（3）常规护理+社区卫生工作者（CHW）;（4）常规护理+护士病例管理员/社区卫生工作者团队。使用的框架的先行-继续行为模式，干预措施包括病人咨询有关的自我保健的做法和医生的建议。149人（84%）完成了2年随访。与住院治疗组相比，NCM组和CHW组在2年内HbA（1c）略有下降（分别为0.3%和0.3%），NCM/CHW联合组HbA（1c）下降幅度更大（0.8%：P = 0.137）。校正基线差异和/或随访时间后，与常规治疗组（-5.6 mmHg; P = 0.042）相比，NCM/CHW联合治疗组的甘油三酯（-35.5 mg/dl; P = 0.041）和舒张压均有所改善。联合NCM/CHW干预可能改善城市非裔美国人2型糖尿病患者的糖尿病控制。尽管结果具有临床重要性，但未达到统计学显著性。这种方法值得进一步关注，以减少非洲裔美国人糖尿病并发症的过度风险。(C)2003年美国健康基金会和爱思唯尔科学（美国）。All rights reserved.
Background. African Americans suffer disproportionately from diabetes complications, but little research has focused on how to improve diabetic control in this population. There are also few or no data on a combined primary care and community-based intervention approach.Methods. We randomly assigned 186 urban African Americans with type 2 diabetes (76% female, mean Angstrom SD age 59 Angstrom 9 years) to 1 of 4 parallel arms: (1) usual care only; (2) usual care + nurse case manager (NCM); (3) usual care + community health worker (CHW); (4) usual care + nurse case manager/community health worker team. Using the framework of the Precede-Proceed behavioral model, interventions included patient counseling regarding self-care practices and physician reminders.Results. The 2-year follow-up visit was completed by 149 individuals (84%). Compared to the Usual care group, the NCM group and the CHW group had modest declines in HbA(1c) over 2 years (0.3 and 0.3%, respectively), and the combined NCM/CHW group had a greater decline in HbA(1c) (0.8%: P = 0.137). After adjustment for baseline differences and/or follow-up time, the combined NCM/CHW group showed improvements in triglycerides (-35.5 mg/dl; P = 0.041) and diastolic blood pressure, compared to the usual care group (-5.6 mmHg; P = 0.042).Conclusions. Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes. Although results were clinically important, they did not reach statistical significance. This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.