Health Promoters and Pharmacists in Diabetes Team Management

描述（由申请人提供）：许多患有糖尿病的非洲裔美国人和拉丁美洲人没有达到正常血糖，血压或胆固醇水平的建议目标，使他们处于并发症的高风险中。这项研究将评估一种新的干预措施的影响，这种干预措施旨在改善生活方式行为和药物依从性，并加强治疗以达到目标。干预的第一个组成部分包括一个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，以达到推荐目标。干预措施的第二个组成部分包括健康促进员或社区非专业卫生工作者。健康促进者通常在少数民族社区中找到，并为邻居提供帮助，克服语言，文化和传统医疗保健服务的其他障碍。他们可以提供自主支持，并解决与药物依从性障碍有关的问题。此外，保健宣传员还可以补充药剂师的活动，改善获得药物的机会，协助与提供者保持护理的连续性，监测对治疗的反应，并加强教育信息。这项拟议的研究将确定是否增加健康促进员，以诊所为基础的药剂师服务提供改善护理。该研究将通过位于芝加哥的伊利诺伊大学医学中心招募300名患有不受控制的糖尿病的非洲裔美国人和拉丁美洲成年人，并随机分为两组：（1）药剂师管理（Pharm）12个月;或（2）HP支持下的药剂师管理（Pharm+HP）12个月。将在12个月时进行交叉，以便通过增加HP支持来加强Pharm组，并从Pharm+HP组中逐步淘汰HP支持，以评估维护。具体目标包括：（1）评价Pharm+HP与Pharm单独治疗相比对糖尿病行为的有效性（包括健康饮食、体力活动和药物依从性）、血红蛋白A1 c、血压和LDL-胆固醇水平;（2）通过在第1年后逐步取消Pharm+HP组的HP支持，评价改善的糖尿病行为的维持以及临床结局;（3）评价单独使用Pharm一年后增加HP所提供的强化;（4）评价Pharm+HP和单独使用Pharm的成本和成本效益。 公共卫生相关性：这项研究评估了一种糖尿病管理干预措施，旨在改善药物依从性和强化治疗，以达到血糖，血压和胆固醇水平的目标。这项研究将确定增加社区健康促进员的药剂师疾病管理服务的好处和成本。如果有好处，那么这种方法可能有助于减少糖尿病及其相关并发症在少数民族糖尿病患者的负担。

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. PUBLIC HEALTH RELEVANCE: This research evaluates a diabetes management intervention designed to improve medication adherence and intensify therapy to reach goals in blood sugar, blood pressure, and cholesterol levels. This study will determine the benefit and cost of adding community health promoters to pharmacist disease management services. If there is benefit, then this approach may help reduce the burden of diabetes and its related complications among minorities with diabetes.