Peer Support for Achieving Independence in Diabetes (Peer AID)

实现糖尿病独立的同伴支持（Peer AID）

• 批准号: 8534848
• 负责人: JAMES W KRIEGER
• 金额: $ 44.07万
• 依托单位: SEATTLE-KING COUNTY PUBLIC HEALTH DEPT
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-10 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8534848
• 关键词: Adopted; Adoption; Affect; Age; Behavior; Blood Glucose; Blood Pressure; Caring; Chronic; Chronic Disease; Client; Clinic; Clinical; Communication; Communities; Community Health; Community Health Centers; Cost Effectiveness Analysis; County; County Hospitals; Data; Diabetes Mellitus; Disease; Economics; Education; Effectiveness; Glycosylated hemoglobin A; Goals; Health; Healthcare Systems; Home environment; Home visitation; Hospitals; House Call; Individual; Intervention; Investments; Knowledge; Link; Lipids; Low Income Population; Low income; Maintenance; Measures; Medical; Minority; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patients; Persons; Physical activity; Planet Mars; Population; Prevalence; Provider; Psyche structure; Public Health; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Research; Research Methodology; Resources; Role; SF-12; Sea; Self Efficacy; Self Management; Social support; System; Telephone; Testing; Translating; Translational Research; Translations; Veterans; Vulnerable Populations; Washington; Work; base; blood lipid; community setting; cost effective; cost effectiveness; diabetes education; evidence base; follow-up; glycemic control; group support; health care service utilization; health disparity; health related quality of life; improved; medication compliance; nutrition; peer; primary outcome; programs; safety net; secondary outcome; skills; treatment as usual

DESCRIPTION (provided by applicant): Type 2 diabetes is an important and common health problem and disproportionately affects low income and minority populations. Acquiring diabetes self- management skills and applying them on a daily basis is challenging, especially for individuals with limited resources. Interventions utilizing community health workers (CHWs) improve knowledge and behavior among persons with diabetes, and in some studies have improved health outcomes. CHWs are a theoretically appealing way to reach vulnerable populations, however, additional work is needed to understand how and in what settings CHWs could most effectively impact diabetes care and reduce health disparities. Information regarding cost- effectiveness and return on investment is also needed. OBJECTIVES: We will test the hypotheses that CHWs providing in-home support for self- management of type 2 diabetes, resources for diabetes, and assistance in effective linkage and communication with medical providers will: (1) improve HbA1c (primary outcome) and secondary outcomes including blood pressure and lipid control, health care utilization, and health-related quality of life; (2) improve diabetes self-management, including self-efficacy, physical activity, nutrition, and medication adherence; and (3) be cost-effective and feasible. METHODS: We will implement a 5-year randomized controlled trial that will compare a CHW model consisting of in home diabetes self-management support, links to group support, and telephone support compared to usual care. CHWs will make up to 5 home visits over the course of a year to provide tailored support in the key components of self-management; referral to group activities including disease self-management classes; generate social support through relationships with their clients; and develop skills to navigate the health care system. At the end of the study period, usual care participants will receive a home visit by a CHW and diabetes self-management resources. The participants will be drawn from an ethnically and culturally diverse group of low-income patients age 30-70 who speak English or Spanish with type 2 diabetes and poorly controlled blood sugar and/or blood pressure who reside in King County, Washington. Participants will be recruited from the local Veterans Affairs (VA) hospital, the county hospital (Harborview) and a community health center (Sea Mar). Our primary outcome will be glycemic control as measured by a HbA1c. Secondary outcomes are blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self- management behaviors. PUBLIC HEALTH RELEVANCE: This study will test the effectiveness of a community health worker intervention that includes home-based diabetes education and links to community resources in a diverse low-income population. We will develop a replicable and sustainable model that can be adopted by community-based organizations and local public health agencies. Given the increasing prevalence of individuals with type 2 diabetes, cost-effective mechanisms are needed to manage the burden of this chronic disease.

描述（由申请人提供）：2 型糖尿病是一种重要且常见的健康问题，对低收入群体和少数族裔影响尤为严重。获得糖尿病自我管理技能并每天应用这些技能具有挑战性，特别是对于资源有限的个人而言。利用社区卫生工作者 (CHW) 进行的干预措施可以改善糖尿病患者的知识和行为，并且在一些研究中还改善了健康结果。社区卫生工作者在理论上是接触弱势群体的一种有吸引力的方式，但是，还需要开展更多工作来了解社区卫生工作者如何以及在什么环境下最有效地影响糖尿病护理并减少健康差距。还需要有关成本效益和投资回报的信息。目标：我们将检验以下假设：社区卫生工作者为 2 型糖尿病自我管理提供家庭支持、糖尿病资源以及协助与医疗提供者进行有效联系和沟通，将：(1) 改善 HbA1c（主要结果）和次要结果，包括血压和血脂控制、医疗保健利用以及与健康相关的生活质量； （2）改善糖尿病自我管理，包括自我效能、身体活动、营养和药物依从性； (3) 具有成本效益且可行。方法：我们将实施一项为期 5 年的随机对照试验，将由家庭糖尿病自我管理支持、团体支持链接和电话支持组成的 CHW 模式与常规护理进行比较。社区卫生工作者将在一年内进行最多 5 次家访，以在自我管理的关键部分提供量身定制的支持；转介参加团体活动，包括疾病自我管理课程；通过与客户的关系产生社会支持；并培养驾驭医疗保健系统的技能。在研究期结束时，常规护理参与者将接受社区卫生工作者的家访和糖尿病自我管理资源。参与者将来自居住在华盛顿州金县的 30-70 岁、具有 2 型糖尿病且血糖和/或血压控制不佳的 30 至 70 岁低收入低收入患者群体。参与者将从当地退伍军人事务部 (VA) 医院、县医院 (Harborview) 和社区卫生中心 (Sea Mar) 招募。我们的主要结果是通过 HbA1c 测量的血糖控制。次要结果是血压、血脂、医疗保健利用率、健康相关的生活质量、自我效能和糖尿病自我管理行为。 公共卫生相关性：本研究将测试社区卫生工作者干预措施的有效性，其中包括家庭糖尿病教育以及与不同低收入人群的社区资源的联系。我们将开发一种可复制且可持续的模式，可供社区组织和当地公共卫生机构采用。鉴于 2 型糖尿病患者的患病率不断增加，需要具有成本效益的机制来管理这种慢性疾病的负担。