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(申请人提供)：许多患有糖尿病的非裔美国人和拉美裔人没有达到正常血糖、血压或胆固醇水平的推荐目标，这使他们面临并发症的高风险。这项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。干预的第一部分包括以诊所为基础的药剂师疾病管理计划。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，以提高服药依从性。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，以达到推荐的目标。干预措施的第二部分包括健康促进员(HPS)，即社区非专业卫生工作者。健康促进员在少数族裔社区很常见，他们为邻居提供帮助，帮助他们克服语言、文化和其他传统医疗服务的障碍。他们可以提供自主支持，并解决与服药依从性障碍有关的问题。此外，健康促进者可以通过改善获得药物的机会、协助提供者持续护理、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。这项拟议的研究将确定在以诊所为基础的药剂师服务提供中增加健康促进剂是否会改善护理。这项研究将通过芝加哥的伊利诺伊大学医学中心招募300名患有未得到控制的糖尿病的非裔美国人和拉丁裔成年人，并将他们随机分成两组之一：(1)药剂师管理(药剂师管理)12个月；或(2)在惠普支持下管理药剂师(制药+惠普)12个月。交叉将在12个月后发生，因此将通过增加惠普支持来加强制药组，并将逐步从制药+惠普组中取消惠普支持，以评估维护。具体目标包括：(1)评估与单独使用辉瑞相比，辉瑞+惠普在糖尿病行为(包括健康饮食、体力活动和用药依从性)、血红蛋白A1c、血压和低密度脂蛋白-胆固醇水平方面的有效性；(2)通过在一年后逐步停止使用辉瑞+惠普的支持，评估改善糖尿病行为以及临床结果的有效性；(3)评估单独使用辉瑞一年后增加惠普的强化效果；以及(4)评估单独使用辉瑞+惠普和单独使用辉瑞的成本和成本效益。