Latinos Understanding the Need for Adherence in Diabetes

描述（由申请人提供）：糖尿病是每年最昂贵的慢性病相关医疗保健费用，某些种族，如拉丁美洲人，受到2型糖尿病（T2DM）负担的影响不成比例。T2DM患者还伴有慢性并发症，这给适当的管理带来了复杂性，并对未来整合初级保健和行为保健的研究产生了影响，特别是在弱势群体中。为了满足最脆弱、资源匮乏的社区的需要，需要采用具有成本效益、可持续和以患者为中心的循证方法进行慢性病管理。综合卫生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一起工作，并使用系统和具有成本效益的方法为确定的人群提供以患者为中心的护理的结果。这种护理可能涉及心理健康状况、健康行为、生活压力和危机以及临床结果。综合护理是有效综合保健的基石，可改善临床结果和生活质量，并降低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政府认可的社区卫生中心（CHC）的综合护理服务。拉丁美洲人了解糖尿病坚持治疗的必要性（LUNA-D）是一项随机对照试验，旨在测试综合行为健康和初级cae慢性护理疾病管理干预对在San Ysidro健康中心（SYHC）就诊的患有2种或以上慢性疾病的低收入2型糖尿病拉丁裔患者的有效性。该研究的目的是：1)改善血糖控制，2)改善心血管风险概况，3)减少心理困扰，4)评估患者和提供者对该计划的接受程度和可持续性。LUNA-D将招募414名患有两种或两种以上慢性疾病的非胰岛素治疗的成年T2DM患者。其中一半将被随机分配到特殊干预组（SI），另一半被随机分配到常规护理组（UC）。SI是一项为期3个月的强化干预，包括与一名行为健康咨询师（BHC）同处一处的中层服务提供者（MLP）进行全面综合的临床访问，以及以同伴为主导的循证小组健康教育会议和积极的护理协调。在高强度干预期之后，SI将接受额外9个月的强化课程和完全整合的MLP/BHC临床访问。常规护理以被动预约初级保健医生和被动转介到行为健康和传统健康教育为代表。HbA1C测量将在基线、3个月、6个月、9个月和12个月进行，以检测血糖控制的变化。临床实验室测量、药物依从性、体重、健康行为和心理社会测量也将在整个研究中获得。临床改善的证明将支持SYHC的采用。

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.