Translating Comparative Effectiveness Research Into Practice: Effects of Interventions on Lifestyle, Medication Adherence, and Self-care for Type 2 Diabetes, Hypertension, and Obesity Among Black, Hispanic, and Asian Residents of Chicago and Houston, 2010 to 2013
Translating Comparative Effectiveness Research Into Practice: Effects of Interventions on Lifestyle, Medication Adherence, and Self-care for Type 2 Diabetes, Hypertension, and Obesity Among Black, Hispanic, and Asian Residents of Chicago and Houston, 2010 to 2013
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DOI：
10.1097/phh.0000000000000525
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发表时间：
2017-09-01
影响因子：
3.3
通讯作者：
Manian, Nanmathi
中科院分区：
文献类型：
--
作者：
Rashid, Jamila R.;Leath, Brenda A.;Manian, Nanmathi
背景：在美国，种族/少数族裔是导致2型糖尿病、高血压和肥胖症的不成比例的疾病和死亡的原因；然而，在比较有效性研究中衡量有效性的干预措施在这些社区往往没有被采用或广泛使用。目的：评估比较有效性研究证实的干预措施在少数族裔社区中的实施和效果。设计：混合方法评估和前测后单组评估设计。地点：美国卫生与公众服务部，少数族裔健康办公室，研究承包商，和顾问委员会；健康中心，包括伊利诺伊州芝加哥的一个联邦合格的社区卫生中心；参与者：共有97名黑人、西班牙裔和亚裔参与者，他们有医疗保健提供者诊断的2型糖尿病、高血压或肥胖的任何组合。干预：在虚拟培训机构中，干预人员学习适应有效干预的文化能力方法。健康教育者在芝加哥提供健康赋权生活方式计划(HELP)；社区药剂师在休斯顿提供MyRx药物依从性计划。主要观察指标：参与率、对2013年1月至4月干预措施的满意度以及干预前后知识、饮食和临床结果的变化。结果：在芝加哥，38名患者的血红蛋白A(1c)和收缩压显著降低，高血压管理知识增加，饮食行为得到改善。在休斯敦，38名补贴住房居民在自我管理知识和坚持糖尿病和高血压药物治疗方面没有统计上的显著进步，但参与药剂师家访和团体教育课程的比例很高。结论：在芝加哥和休斯顿，HELP和MyRx的适应、采用和实施显示了干预后种族/民族参与者的重要变化。这些社区在不同的环境、变化的目标和城市都面临着类似的实施挑战。现有资源不足以维持惠益，并在研究期间对种族/族裔差距产生可衡量的影响。结果表明，需要进行持续时间更长、权力更大的实施研究，并突出能够在社区范围内持续长期干预的政策和方案。
Context: In the United States, racial/ethnic minorities account for disproportionate disease and death from type 2 diabetes, hypertension, and obesity; however, interventions with measured efficacy in comparative effectiveness research are often not adopted or used widely in those communities.Objective: To assess implementation and effects of comparative effectiveness research-proven interventions translated for minority communities.Design: Mixed-method assessment with pretest-posttest single-group evaluation design.Setting: US Department of Health and Human Services, Office of Minority Health, research contractor, and advisory board; health centers, including a federally qualified community health center in Chicago, Illinois; and public housing facilities for seniors in Houston, Texas.Participants: A total of 97 black, Hispanic, and Asian participants with any combination of health care provider-diagnosed type 2 diabetes, hypertension, or obesity.Interventions: Virtual training institutes where intervention staff learned cultural competency methods of adapting effective interventions. Health educators delivered the Health Empowerment Lifestyle Program (HELP) in Chicago; community pharmacists delivered the MyRx Medication Adherence Program in Houston.Main Outcome Measures: Participation rates, satisfaction with interventions during January to April 2013, and pre- to postintervention changes in knowledge, diet, and clinical outcomes were analyzed through July 2013.Results: In Chicago, 38 patients experienced statistically significant reductions in hemoglobin A(1c) and systolic blood pressure, increased knowledge of hypertension management, and improved dietary behaviors. In Houston, 38 subsidized housing residents had statistically nonsignificant improvements in knowledge of self-management and adherence to medication for diabetes and hypertension but high levels of participation in pharmacist home visits and group education classes.Conclusion: Adaptation, adoption, and implementation of HELP and MyRx demonstrated important postintervention changes among racial/ethnic participants in Chicago and Houston. The communities faced similar implementation challenges across settings, targets of change, and cities. Available resources were insufficient to sustain benefits with measurable impact on racial/ethnic disparities beyond the study period. Results suggest the need for implementation studies of longer duration, greater power, and salience to policies and programs that can sustain longterm interventions on a community-wide scale.