Latinos Understanding the Need for Adherence in Diabetes

拉丁美洲人了解糖尿病患者坚持治疗的必要性

• 批准号: 9247723
• 负责人: Gregory A Talavera
• 金额: $ 55.96万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9247723
• 关键词: 20 year old; Acute; Address; Adherence; Adoption; Adult; Affect; American; Anxiety; Appointment; Behavior Therapy; Behavioral; Blood Pressure; Body mass index; California; Caring; Cholesterol; Chronic; Chronic Care; Chronic Disease; Clinical; Communities; Community Health Centers; Community Healthcare; Comorbidity; Data; Diabetes Mellitus; Diastolic blood pressure; Disadvantaged; Disease Management; Distress; Education; Effectiveness; Electronic Health Record; Elements; Ethnic group; Evaluation; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health Services Accessibility; Health behavior; Health behavior change; Health education; Healthcare; Healthcare Systems; Hispanics; Hospitalization; Intervention; Latino; Life; Linguistics; Low income; Measurement; Measures; Medical; Mental Depression; Mental Health; Mexican; Mexico; Moods; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Participant; Patient Self-Report; Patient-Centered Care; Patients; Peer Group; Pharmacy facility; Philosophy; Population; Prevalence; Primary Care Physician; Primary Health Care; Process; Professional counselor; Program Sustainability; Provider; Quality of life; Randomized; Randomized Controlled Trials; Records; Recruitment Activity; Research; Resources; Self Management; Services; Testing; Triglycerides; United States; Universities; Visit; Vulnerable Populations; Weight; base; behavioral health; behavioral outcome; blood lipid; cardiovascular disorder risk; cardiovascular risk factor; care delivery; chronic care model; clinical care; collaborative care; cost; cost effective; design; disorder control; evidence base; glycemic control; health care model; health disparity; improved; medication compliance; patient oriented; patient registry; peer; physical conditioning; primary care setting; programs; psychological distress; psychosocial; public health relevance; randomized trial; stressor; symptomatology; treatment as usual

DESCRIPTION (provided by applicant): Diabetes incurs the most expensive annual chronic disease-related health care costs and certain ethnic groups, such as Latinos, are disproportionately affected by the burden of Type 2 Diabetes Mellitus (T2DM). Patients with T2DM also have comorbid chronic conditions that create complexities for proper management, and have implications for future research on integrating primary and behavioral care, particularly in dis- advantaged groups. Cost-effective, sustainable, and patient-centered adaptations of evidence-based approaches to chronic disease management are needed to meet the needs of the most vulnerable, low- resource communities. Integrated Health Care is the care that results from a practice team of primary care and behavioral health clinicians working together with patients and using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health conditions, health behaviors, life stressors and crises, and clinical outcomes. Care integration is a cornerstone of effective integrated health care that leads to improved clinical and quality of life outcomes and reduces health-care costs and hospitalizations, especially in vulnerable populations. The goal of this project is to improve integrated care services at a federally-qualified Community Health Center (CHC). Latinos Understanding the Need for Adherence in Diabetes (LUNA-D), is a randomized controlled trial that will test the effectiveness of an integrated behavioral health and primary cae chronic care disease management intervention for low income T2DM Latino patients with 2 or more chronic conditions accessing care within San Ysidro Health Center (SYHC). The study aims are to: 1) improve glycemic control, 2) improve cardiovascular risk profiles, 3) decrease psychological distress, and 4) evaluate the patient and provider acceptability and sustainability of the program. LUNA-D will recruit 414 non-insulin using adult T2DM patients with 2 or more chronic diseases. Half will be randomized to the Special Intervention (SI) and half to Usual Care (UC). The SI is a 3-month intensive intervention including fully integrated clinical visits with a mid-level provider (MLP) co-located with a behavioral health counselor (BHC) and peer-led evidence-based group health education sessions and proactive care coordination. Following the intense intervention period, the SI will receive booster sessions and fully integrated MLP/BHC clinical visits across 9 additional months. Usual Care is represented by passive appointments with the primary care physician and passive referrals to behavioral health and traditional health education. HbA1C measurements will be taken at baseline, 3-, 6-, 9- and 12-months to detect changes in glycemic control. Clinical lab measures, medication adherence, weight, health behaviors and psychosocial measures will also be obtained across the study. Demonstration of clinical improvement will support adoption by the SYHC.

描述（由申请人提供）：糖尿病引起最昂贵的年度慢性病相关医疗保健费用，某些种族群体，如拉丁美洲人，不成比例地受到2型糖尿病（T2 DM）负担的影响。2型糖尿病患者还患有慢性共病，这给适当的管理带来了复杂性，并对未来整合初级和行为护理的研究产生了影响，特别是在糖尿病患者中。成本效益高，可持续，以病人为中心的适应性的循证方法，以慢性病管理，以满足最脆弱的，低资源的社区的需要。综合医疗保健是由初级保健和行为健康临床医生组成的实践团队与患者合作，并使用系统和具有成本效益的方法为特定人群提供以患者为中心的护理。这种护理可以解决心理健康状况，健康行为，生活压力和危机以及临床结果。一体化护理是有效的综合保健的基石，可改善临床和生活质量，减少保健费用和住院治疗，特别是在弱势群体中。该项目的目标是改善联邦合格的社区卫生中心（CHC）的综合护理服务。拉丁美洲人了解糖尿病患者依从性需求（LUNA-D）是一项随机对照试验，将测试综合行为健康和初级慢性病护理疾病管理干预对患有2种或2种以上慢性病的低收入T2 DM拉丁美洲患者的有效性，这些患者在圣伊西德罗健康中心（SYHC）接受护理。研究的目的是：1）改善血糖控制，2）改善心血管风险状况，3）减少心理困扰，以及4）评估患者和提供者对该计划的可接受性和可持续性。LUNA-D将招募414名患有2种或2种以上慢性疾病的成人T2 DM患者。一半将随机分配至特殊干预（SI），另一半将随机分配至家庭护理（UC）。SI是一项为期3个月的强化干预，包括与中级提供者（MLP）和行为健康顾问（BHC）共同定位的完全整合的临床访视，以及同行领导的循证小组健康教育课程和积极的护理协调。在密集干预期之后，SI将在另外9个月内接受加强治疗和完全整合的MLP/BHC临床访视。家庭护理的代表是被动预约初级保健医生和被动转介到行为健康和传统的健康教育。将在基线、3、6、9和12个月时测量HbA 1C，以检测血糖控制的变化。还将在整个研究期间获得临床实验室指标、药物依从性、体重、健康行为和心理社会指标。临床改善的证明将支持SYHC的采用。