Improving the Care of Youth With Type 1 Diabetes With a Novel Medical-Legal Community Intervention: The Diabetes Community Care Ambassador Program
Improving the Care of Youth With Type 1 Diabetes With a Novel Medical-Legal Community Intervention: The Diabetes Community Care Ambassador Program
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通过新型医疗法律社区干预措施改善 1 型糖尿病青少年的护理：糖尿病社区护理大使计划
DOI：
10.1177/0145721717750346
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
C. Pihoker
中科院分区：
文献类型：
--
作者：
Faisal S. Malik;J. Yi;C. Taplin;C. Roth;K. Whitlock;Waylon Howard;C. Pihoker
目的 本研究的目的是检验糖尿病社区关怀大使 (DCCA) 计划的可行性和有效性，这是一项新颖的医疗法律社区干预措施，旨在支持患有 1 型糖尿病的高危青少年。方法 研究资格标准：年龄 3-19 岁、A1C ≥8.5% (≥69 mmol/mol) 和/或近期因糖尿病酮症酸中毒住院、1 型糖尿病病程≥1 年、讲英语或西班牙语。 89 名青少年及其照顾者参加了为期 9 至 12 个月的干预措施，其中包括通过 3 次家访、1 至 2 次学校访问提供的糖尿病教育和支持、非专业卫生工作者的电话支持以及医疗法律合作律师的法律支持。评估了可行性； A1C 的变化在线性混合模型中进行比较。结果 在 89 名 DCCA 计划参与者中，80% 完成了该计划，大多数参与者对 DCCA 给予好评。 62% 的人报告有 ≥1 项未满足的法律需求，其中 29% 接受了法律咨询。参加 DCCA 计划的青少年的血糖控制有所改善，他们的平均 A1C 从计划开始时的 9.71% (83 mmol/mol) 下降到干预期结束时的 9.40% (79 mmol/mol) (P = .03)。拥有公共健康保险的参与者 A1C 下降幅度最大（9.79% 至 9.11%，83 mmol/mol 至 76 mmol/mol）。结论 DCCA 计划是改善 1 型糖尿病高危青少年护理的一项有前途的干预措施。很大一部分青少年的照顾者报告称其法律需求未得到满足。参与者仍然高度参与，并表现出血糖控制得到改善，特别是拥有公共健康保险的年轻人。
Purpose The purpose of this study was to examine the feasibility and efficacy of the Diabetes Community Care Ambassador (DCCA) Program, a novel medical-legal community intervention designed to support high-risk youth with type 1 diabetes. Methods Study eligibility criteria: ages 3-19 years, A1C ≥8.5% (≥69 mmol/mol) and/or recent diabetic ketoacidosis hospitalization, type 1 diabetes duration ≥1 year, and English- or Spanish-speaking. Eighty-nine youth and their caregivers participated in the 9- to 12-month intervention, which included diabetes education and support through 3 home visits, 1 to 2 school visits, and phone support from a lay health worker, as well as legal support from a medical-legal partnership attorney. Feasibility was assessed; change in A1C was compared in a linear mixed model. Results Of the 89 DCCA Program participants, 80% completed the program, with the majority of participants rating their DCCA favorably. Sixty-two percent reported ≥1 unmet legal need, of whom 29% accepted legal counsel. Youth enrolled in the DCCA Program demonstrated an improvement in glycemic control as their mean A1C decreased from 9.71% (83 mmol/mol) at the start of the program to 9.40% (79 mmol/mol) at the end of the intervention period (P = .03). Participants with public health insurance experienced the greatest differential A1C reduction (9.79% to 9.11%, 83 mmol/mol to 76 mmol/mol). Conclusions The DCCA Program represents a promising intervention for improving care of high-risk youth with type 1 diabetes. A significant proportion of caregivers of youth reported having an unmet legal need. Participants remained highly engaged and demonstrated improved glycemic control, particularly youth with public health insurance.
减少 1 型糖尿病青少年的急性不良后果：一项随机对照试验。
影响因子：
8
作者：
Svoren,BrittaM;Butler,Deborah;Levine,Bat-Sheva;Anderson,BarbaraJ;Laffel,LoriMB
通讯作者：
Laffel,LoriMB