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

基本信息

批准号：
8245846
负责人：
Ben Steven Gerber
金额：
$ 66.95万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-05-01 至 2016-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8245846
关键词：
Address Adherence Adult Affect African American American Behavior Behavior Therapy Behavioral 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 Economics 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 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 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 high risk improved medication compliance meetings novel primary care setting programs promoter psychologic response social therapy design treatment planning

项目摘要

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.

描述（由申请人提供）：许多非裔美国人和糖尿病的拉丁美洲人无法实现正常血糖，血压或胆固醇水平的建议目标，从而使它们处于并发症的高风险。这项研究将评估一种新颖的干预措施的影响，旨在改善生活方式行为和药物依从性，并加强疗法以实现目标。干预措施的第一个组成部分包括基于诊所的药剂师疾病管理计划。该计划包括详细的患者评估，医师批准的治疗计划，患者教育和支持服务，以增强药物依从性。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的目标。干预的第二部分包括健康促进者（HPS）或基于社区的外行健康工作者。健康推广者通常在少数民族社区中发现，并为邻居克服了传统医疗服务的邻居，文化和其他障碍。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，健康促进者可以通过改善药物获取，协助与提供者的连续性，监测对治疗的反应并加强教育信息来补充药剂师活动。拟议的研究将确定在基于诊所的药剂师服务中加入健康启动子是否可以改善护理。该研究将涉及通过芝加哥伊利诺伊大学医学中心的300名非裔美国人和拉丁裔成年人患有不受控制的糖尿病，并随机分为两组：（1）12个月的药剂师管理（Pharm）；或（2）具有HP支持（Pharm+HP）的药剂师管理12个月。交叉将在12个月内发生，以便通过增加HP支持来加强药物组，并将从Pharm+HP组逐步淘汰HP支持以评估维护。具体目的包括：（1）与单独使用药物对糖尿病行为（包括健康饮食，体育锻炼和药物依从性），血红蛋白A1C，血压和LDL-胆固醇水平相比，评估Pharm+HP的有效性；（2）评估维持改善的糖尿病行为以及临床结果，通过逐步逐步淘汰Pharm+HP组后的HP支持；（3）评估仅在制药一年后添加HP提供的强化；（4）单独评估Pharm+HP和Pharm的成本和成本效益。公共卫生相关性：这项研究评估了糖尿病管理干预措施，旨在提高药物依从性并加强治疗，以达到血糖，血压和胆固醇水平的目标。这项研究将确定将社区健康促进者添加到药剂师疾病管理服务中的好处和成本。如果有益处，那么这种方法可能有助于减轻糖尿病及其相关并发症的负担。