Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
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DOI：
10.7326/m13-3012
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发表时间：
2014-11-18
影响因子：
39.2
通讯作者：
An LC
中科院分区：
文献类型：
--
作者：
Heisler M;Choi H;Palmisano G;Mase R;Richardson C;Fagerlin A;Montori VM;Spencer M;An LC
为低收入社区服务的医疗保健中心缺乏资源来支持糖尿病控制不佳的患者的药物决策。我们比较了社区卫生工作者（CHW）使用定制的交互式基于网络的平板电脑交付工具（iDecide）与使用印刷教育材料之间的结果。2011-2013年的一项随机双组试验。试验注册NCT 01427660。底特律的社区健康中心为拉丁裔和非洲裔美国人的低收入人群提供服务。188名血红蛋白A1 c>7.5%（55%）或报告有问题、担忧或难以服用糖尿病药物的成人（1 R18 HS 019256 -01）和P30 DK 092926（MCDTR）主要结局是关于抗高血糖药物知识的变化，患者报告的药物决策冲突，和对降糖药物信息的满意度。我们还检查了糖尿病困扰，自我效能，药物依从性和A1 c的变化。参与者被随机分配使用iDecide或印刷教育材料与CHW进行1-2小时的会议，并接受两次后续电话会议。94%的参与者完成了3个月的随访。两组在大多数指标上都有所改善。与印刷材料组相比，iDecide参与者报告了对药物信息的满意度（帮助，p= 0.007;清晰度，p= 0.03）和糖尿病困扰的改善（p<0.001）。两组在其他结局方面没有差异。这项研究是在一个健康中心进行的，时间很短，CHW在行为咨询方面很有经验，因此可能减少对额外支持工具的需求。在接受两种类型糖尿病药物决策支持的参与者中，大多数结果都得到了类似的改善。有必要进行长期评估，以确定iDecide组在三个月时对药物信息和糖尿病困扰的满意度的更大改善是否会转化为更好的长期糖尿病结局。
Health care centers serving low-income communities have scarce resources to support medication decision-making among patients with poorly controlled diabetes. We compared outcomes between community health worker (CHW) use of a tailored, interactive web-based tablet-delivered tool (iDecide) versus use of print educational materials. A randomized two-arm trial from 2011-2013. Trial Registration NCT01427660. Community health center in Detroit serving a Latino and African American low-income population. 188 adults with a hemoglobinA1c >7.5% (55%) or who reported questions, concerns, or difficulty taking diabetes medications Agency for Health Care Quality and Research (1R18HS019256-01) and P30DK092926 (MCDTR) Primary outcomes were changes in knowledge about anti-hyperglycemic medications, patient-reported medication decisional conflict, and satisfaction with anti-hyperglycemic medication information. We also examined changes in diabetes distress, self-efficacy, medication adherence, and A1c. Participants were randomized to receive a 1-2 hour session with a CHW using either iDecide or printed educational materials and two follow-up calls. 94% of participants completed three-month follow-up. Both groups improved across most measures. iDecide participants reported greater improvements in satisfaction with medication information (helpfulness, p=.007; clarity, p=.03) and in diabetes distress compared to the print materials group (p<0.001). There were no differences between groups in other outcomes. The study was conducted at one health center over a short period, and the CHWs were experienced in behavioral counseling, thus possibly mitigating the need for additional support tools. Most outcomes were similarly improved among participants receiving both types of diabetes medication decision-making support. Longer-term evaluations are necessary to determine whether the greater improvements in satisfaction with medication information and diabetes distress achieved in the iDecide group at three months translate into better longer-term diabetes outcomes.