Technologically Enhanced Community Health Worker (CHW) Delivery of Personalized D

描述(由申请人提供)：药物治疗是糖尿病治疗的关键组成部分。成功的药物管理需要启动和滴定药物的提供者与坚持治疗方案的患者之间的合作。然而，服药依从性差和未能加强用药的比率很高。向患者提供关于可用药物的潜在益处、危害、成本和负担的充分信息，并讨论患者的治疗偏好和限制，对于改善依从性和药物管理至关重要。然而，对于短暂的诊所访问来说，这种讨论可能过于复杂和耗时。此外，虽然有关于糖尿病药物的良好、循证的信息，但市中心的少数民族糖尿病成年人往往无法获得这些信息，他们的健康素养和算术能力较低，保险覆盖范围较差或没有保险，英语水平有限(LEP)。对于这些成年人来说，要做出有效的药物治疗和其他糖尿病自我管理决策，他们必须能够获得、处理和应用及时和准确的信息，以便进行临床和行为决策。然而，许多人缺乏可用的工具来分享决策或就他们的糖尿病药物做出明智的决定。医疗保健研究和质量机构(AHRQ)编制了比较有效性研究总结指南(CERSGs)，通过向患者/消费者、临床医生和政策制定者传播研究结果，帮助弥合研究与实践之间的差距。其中两本指南《2型糖尿病的药片：成人指南》和《2型糖尿病的预混胰岛素》概述了有关糖尿病的性质、糖尿病护理的不同方面的作用以及不同口服药物和胰岛素类型之间的益处和差异的研究。这些指南中的信息可能对低资源社区中服务不足的少数民族和少数族裔成年人非常有用，以评估他们目前的糖尿病治疗并确定改善他们的护理计划的机会，以便与他们的卫生保健提供者讨论。然而，首先，需要修改这些指南的内容呈现和交付机制，以增加它们在这些难以接触到的人群中的使用和影响。为了实现这一目标，底特律市中心的非裔美国人和拉丁裔社区组织、医疗保健中心和系统、公共卫生组织和学者之间的长期合作(REACH底特律伙伴关系)正在与领先的专家一起开发个人和文化定制的健康决策辅助工具(密歇根大学的健康传播研究中心[CHCR]和医学行为和决策科学中心[CBDSM])。我们建议开发和评估一种计算机定制的干预措施，以帮助社区卫生工作者(CHWS)或其他外展工作者向识字率低、糖尿病的非裔美国人和讲英语和西班牙语、血糖控制较差的拉丁裔成年人提供关于口服降血糖药物和胰岛素的个性化患者教育材料。 公共卫生相关性：我们建议在随机对照试验中开发和评估一种计算机定制干预措施，以帮助社区卫生工作者(CHWS)或其他外展工作者为低识字率、糖尿病非裔美国人和讲英语和西班牙语、血糖控制较差的拉丁裔成年人提供关于口服抗高血糖药物和胰岛素的个性化患者教育材料。

DESCRIPTION (provided by applicant): Pharmacological therapy is a critical component of diabetes treatment. Successful medications management requires a partnership between providers who initiate and titrate medications and patients who adhere to the regimen. Yet, there are high rates both of poor medication adherence and failure to intensify medications. Providing adequate information to patients about the potential benefits, harms, costs, and burdens of available medications and discussing patients' treatment preferences and constraints are essential for improved adherence and medication management. This discussion, however, can be too complex and time-consuming for brief clinic visits. Moreover, while there is good, evidence-based information on diabetes medications, such information is often inaccessible to inner-city minority diabetic adults with low health literacy and numeracy, poor or no insurance coverage, and limited English proficiency (LEP). For these adults to make effective medication and other diabetes self-management decisions, they must be able to obtain, process, and apply timely and accurate information for clinical and behavioral decision making. Yet, many lack the tools available to share in decision making or to make an informed decision about their diabetes medications. The Agency for Healthcare Research and Quality (AHRQ) has produced Comparative Effectiveness Research Summary Guides (CERSGs) to help bridge the gap between research and practice by disseminating research findings to patients/consumers, clinicians, and policymakers. Two of these guides, "Pills for Type 2 Diabetes: A Guide for Adults" and "Premixed Insulin for Type 2 Diabetes" summarize research on the nature of diabetes, the role of different aspects of diabetes care, and the benefits and differences among different oral medications and types of insulin. The information in these guides could be of great use to underserved ethnic and racial minority adults in low resource communities to assess their current diabetes treatment and identify opportunities for improvement in their care plan to discuss with their health care providers. First, however, the content presentation and delivery mechanisms of these Guides need to be modified to increase their use and impact among these difficult-to-reach populations. To achieve this goal, a long-standing collaboration among inner-city Detroit African American and Latino community organizations, health care centers and systems, public health organizations, and academics (the REACH Detroit Partnership) is joining with leading experts in the development of personally and culturally tailored health decision aids (University of Michigan's Center for Health Communications Research [CHCR] and Center for Behavioral and Decision Sciences in Medicine [CBDSM]). We propose to develop and evaluate a computer tailored intervention to assist community health workers (CHWs) or other outreach workers to provide personalized patient education materials on oral anti-hyperglycemic medications and insulin to low-literacy, diabetic African American and English- and Spanish-speaking Latino adults with poor glycemic control. PUBLIC HEALTH RELEVANCE: We propose to develop and evaluate in a randomized controlled trial a computer tailored intervention to assist community health workers (CHWs) or other outreach workers to provide personalized patient education materials on oral anti-hyperglycemic medications and insulin to low-literacy, diabetic African American and English and Spanish-speaking Latino adults with poor glycemic control.