Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial
Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial
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DOI：
10.2105/ajph.2017.303985
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发表时间：
2017-10-01
影响因子：
12.7
通讯作者：
Long, Judith A.
中科院分区：
文献类型：
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作者：
Kangovi, Shreya;Mitra, Nandita;Long, Judith A.
目标。目的：确定社区卫生工作者（CHW）干预是否能改善患有多种慢性疾病的低收入人群的预后。我们在宾夕法尼亚州费城进行了一项单盲随机临床试验（2013-2014）。参与者（n = 302）是高贫困社区居民，无保险或公共保险，诊断患有2种或2种以上慢性疾病（糖尿病，肥胖，烟草依赖，高血压）。所有患者都设定了一个疾病管理目标。随机分配到卫生保健中心的患者也接受了根据他们的目标和偏好量身定制的6个月的支持。来自chw的支持（与单独设定目标相比）导致了几种慢性疾病的改善（糖化血红蛋白的变化：-0.4 vs . 0.0；体重指数：-0.3 vs . -0.1；每天吸烟：-5.5 vs . -1.3；收缩压：-1.8 vs . -11.2；总体P=.08）、自评心理健康（12项简短问卷调查；2.3 vs . -0.2； P=.008）和护理质量（医疗服务提供者和系统的消费者评估；62.9% vs . 38%； P= 0.08）
Objectives. To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions.Methods. We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences.Results. Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P=.08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P=.008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P