Health Promoters and Pharmacists in Diabetes Team Management

糖尿病团队管理中的健康促进者和药剂师

• 批准号: 8813560
• 负责人: Ben Steven Gerber
• 金额: $ 63.5万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8813560
• 关键词: Address; Adherence; Adult; Affect; African American; American; Behavior; Behavior Therapy; Belief; Blood Glucose; Blood Pressure; Caring; Chicago; Cholesterol; Chronic Disease; Clinic; Clinical; Communities; Community Health; Complement; Complex; Continuity of Patient Care; Costs and Benefits; Crossover Design; Data; Diabetes Mellitus; Diagnosis; Disease Management; Eating; Effectiveness; Environment; Genetic Crossing Over; Glycosylated hemoglobin A; Goals; Health; Health Professional; Health Services; Hispanics; Housing; Illinois; Improve Access; Intervention; LDL Cholesterol Lipoproteins; Language; Latino; Life Style; Limited English Proficiency; Maintenance; Medical center; Medication Management; Minority; Minority Groups; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Education; Patients; Pharmaceutical Preparations; Pharmacists; Phase; Physical activity; Physicians; Population; Primary Health Care; Problem Solving; Provider; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Resources; Role; Services; Support Groups; Testing; Therapeutic; Underrepresented Minority; Universities; base; behavioral economics; burden of illness; compliance behavior; cost; cost effectiveness; design; diabetes education; diabetes management; diabetes mellitus therapy; disorder risk; effective intervention; experience; glycemic control; health literacy; healthy lifestyle; high risk; improved; medication compliance; meetings; novel; primary care setting; programs; promoter; psychologic; response; social; therapy design; treatment planning

DESCRIPTION (provided by applicant): Many African-Americans and Latinos with diabetes do not achieve the recommended goals for normal blood sugar, blood pressure, or cholesterol level, placing them at high risk for complications. This study will evaluate the impact of a novel intervention designed to improve lifestyle behaviors and medication adherence, and intensify therapy to reach goals. The first component of the intervention includes a clinic-based pharmacist disease management program. The program includes detailed patient assessments, physician- approved treatment plans, patient education and support services to enhance medication adherence. In addition, this program includes intensification of medication therapy to improve blood sugar, blood pressure, and cholesterol levels to reach recommended goals. The second component of the intervention includes health promoters (HPs), or community-based lay health workers. Health promoters are commonly found in minority communities and provide assistance for neighbors overcoming language, cultural, and other barriers to conventional health care services. They may provide autonomy support and solve problems related to medication adherence barriers. Furthermore, health promoters may complement pharmacist activities by improving access to medications, assisting in continuity of care with providers, monitoring response to therapy, and reinforcing educational messages. The proposed study will determine whether the addition of health promoters to clinic based pharmacist service delivery improves care. The study will involve the recruitment of 300 African-American and Latino adults with uncontrolled diabetes through the University of Illinois Medical Center in Chicago and randomization to one of two groups: (1) pharmacist management (Pharm) for 12 months; or (2) pharmacist management with HP support (Pharm+HP) for 12 months. Cross-over will occur at 12 months such that the Pharm group will be intensified by the addition of HP support and HP support will be phased out from the Pharm+HP group to assess maintenance. The specific aims include: (1) To evaluate the effectiveness of Pharm+HP compared with Pharm alone on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels; (2) To evaluate the maintenance of improved diabetes behaviors as well as clinical outcomes by phasing out HP support from the Pharm+HP group after year 1; (3) To evaluate the intensification offered by adding an HP after one year of Pharm alone; and (4) To evaluate the cost and cost-effectiveness of Pharm+HP and Pharm alone.

描述（由申请人提供）：许多患有糖尿病的非裔美国人和拉丁裔美国人没有达到正常血糖、血压或胆固醇水平的推荐目标，使他们处于并发症的高风险中。本研究将评估一种旨在改善生活方式行为和药物依从性的新型干预措施的影响，并加强治疗以达到目标。干预的第一个组成部分包括基于临床的药剂师疾病管理程序。该计划包括详细的患者评估，医生批准的治疗计划，患者教育和支持服务，以提高药物依从性。此外，该计划还包括加强药物治疗，以改善血糖、血压和胆固醇水平，以达到建议的目标。干预措施的第二个组成部分包括健康促进者（HPs），或以社区为基础的非专业卫生工作者。健康促进者通常出现在少数民族社区，帮助邻居克服语言、文化和其他障碍，获得传统的卫生保健服务。他们可以提供自主支持，并解决与药物依从性障碍相关的问题。此外，健康促进员可以通过改善药物获取、协助提供者提供连续性护理、监测对治疗的反应以及加强教育信息来补充药剂师的活动。拟议的研究将确定是否增加健康促进者的诊所为基础的药剂师服务提供改善护理。该研究将通过芝加哥伊利诺伊大学医学中心招募300名患有未控制糖尿病的非裔美国人和拉丁裔成年人，并随机分为两组：(1)药剂师管理（Pharm） 12个月；(2)在HP支持下（Pharm+HP）进行药师管理，为期12个月。交叉将在12个月后进行，这样Pharm组将通过增加HP支持而得到加强，HP支持将从Pharm+HP组中逐步退出，以评估维护。具体目的包括：(1)比较Pharm+HP与单独使用Pharm对糖尿病行为（包括健康饮食、体力活动和药物依从性）、血红蛋白A1c、血压和ldl -胆固醇水平的影响；(2)通过在1年后逐步取消Pharm+HP组的HP支持，评估改善的糖尿病行为的维持情况以及临床结果；(3)评价单独用药一年后加HP的强化效果；(4)评估Pharm+HP和单独Pharm的成本和成本效益。