Latinos Understanding the Need for Adherence in Diabetes

描述(申请人提供)：糖尿病每年产生最昂贵的慢性病相关医疗费用，某些种族群体，如拉丁裔，受到2型糖尿病(T2 DM)负担的不成比例的影响。T2 DM患者还伴有慢性疾病，这为适当的治疗创造了复杂性，并对未来整合初级和行为护理的研究产生了影响，特别是在弱势群体中。需要以成本效益、可持续的和以患者为中心的循证方法来适应慢性病管理，以满足最脆弱、低资源社区的需求。综合医疗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合作，使用系统和成本效益的方法为特定人群提供以患者为中心的护理的结果。这种护理可以解决精神健康状况、健康行为、生活应激源和危机以及临床结果。综合保健是有效综合保健的基石，可改善临床和生活质量，减少保健费用和住院费用，特别是在弱势人群中。该项目的目标是改善联邦合格社区卫生中心(CHC)的综合护理服务。这是一项针对拉美裔糖尿病患者的随机对照试验，名为“了解糖尿病患者坚持治疗的必要性”(露娜-D)，旨在测试综合行为健康和初级CAE慢性护理疾病管理干预措施对患有两种或两种以上慢性病并在圣伊西德罗健康中心接受治疗的低收入拉丁裔患者的有效性。这项研究的目的是：1)改善血糖控制，2)改善心血管风险状况，3)减少心理困扰，4)评估患者和提供者对该计划的可接受性和可持续性。露娜-D将招募414名患有2种或2种以上慢性病的成年T2 DM患者。一半将被随机分配到特别干预组(SI)，另一半将被随机分配到普通护理组(UC)。SI是一项为期3个月的强化干预，包括与行为健康顾问(BHC)共同定位的中层提供者(MLP)的完全整合的临床访问，以及同行领导的循证小组健康教育课程和主动护理协调。在紧张的干预期之后，SI将在另外9个月内接受助推器会议和完全整合的MLP/BHC临床访问。日常护理表现为与初级保健医生的被动预约以及被动转介到行为健康和传统健康教育。在基线、3个月、6个月、9个月和12个月时进行HbA1c测量，以检测血糖控制的变化。临床实验室测量、用药依从性、体重、健康行为和心理社会测量也将在整个研究中获得。临床改善的展示将支持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.