Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program.
Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program.
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DOI：
10.1097/fch.0000000000000311
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发表时间：
2022-01-01
影响因子：
2.3
通讯作者：
Billimek, John
中科院分区：
文献类型：
--
作者：
Slater, Allison;Cantero, Patricia J.;Alvarez, Guillermo;Cervantes, Brett S.;Bracho, America;Billimek, John
关键词：
社区发起的卫生干预措施填补了获得卫生服务方面的重要空白。本研究通过回顾性观察研究，探讨了社区发起的健康干预措施对改善服务不足的有色人种社区糖尿病管理的有效性，并将拉丁裔健康获取糖尿病自我管理计划 (LHA-DSMP) 等研究干预措施与常规护理进行了比较。 LHA-DSMP 是一项为期 12 期的社区卫生工作者 (promotor/a) 干预措施，由医疗服务不足地区的社区组织制定和实施。通常的护理是在同一地理区域的联邦合格健康中心提供的。参与者是 688 名主要讲西班牙语的拉丁裔 2 型糖尿病成年人。主要结果是血糖控制（糖化血红蛋白 [HbA1c]）从基线到随访的变化。 14 周随访时，LHA-DSMP 队列中 HbA1c 平均 (95% CI) 降低为 -1.1 (-1.3 至 -0.9; P < .001)，而对照组为 -0.3 (-0.4 至 -0.2; P < .001)。控制队列之间的基线差异后，HbA1c 的调整后的双重差异值为 -0.6（-0.8 至 -0.3；P < .001），有利于 LHA-DSMP。由社区发起的促进者/主导的糖尿病自我管理教育计划与血糖控制的临床显着改善相关，优于常规医疗护理所观察到的效果。
Community-initiated health interventions fill important gaps in access to health services. This study examines the effectiveness of a community-initiated health intervention to improve diabetes management in an underserved community of color using a retrospective observational study, comparing a study intervention, the Latino Health Access Diabetes Self-Management Program (LHA-DSMP), with usual care. The LHA-DSMP is a 12-session community health worker (promotor/a) intervention developed and implemented by a community-based organization in a medically underserved area. Usual care was delivered at a federally qualified health center in the same geographic area. Participants were 688 predominantly Spanish-speaking Latinx adults with type 2 diabetes. The main outcome was change in glycemic control (glycosylated hemoglobin [HbA1c]) from baseline to follow-up. At 14-week follow-up, mean (95% CI) HbA1c decrease was −1.1 (−1.3 to −0.9; P < .001) in the LHA-DSMP cohort compared with −0.3 (−0.4 to −0.2; P < .001) in the comparison cohort. Controlling for baseline differences between cohorts, the adjusted difference-in-differences value in HbA1c was −0.6 (−0.8 to −0.3; P < .001) favoring the LHA-DSMP. A community-initiated promotor/a-led educational program for diabetes self-management is associated with clinically significant improvement in blood sugar control, superior to what was observed with usual medical care.