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：
8627602
负责人：
Ben Steven Gerber
金额：
$ 63.8万
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/8627602
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.

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裔美国人没有达到正常血糖、血压或胆固醇水平的建议目标，使他们面临并发症的高风险。这项研究将评估旨在改善生活方式和药物依从性的新型干预措施的影响，并强化治疗以实现目标。干预措施的第一个组成部分包括基于临床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，以提高用药依从性。此外，该计划还包括强化药物治疗，以改善血糖、血压和胆固醇水平，以达到建议的目标。干预措施的第二个组成部分包括健康促进者 (HP) 或社区非专业卫生工作者。健康促进者常见于少数族裔社区，他们为邻居提供帮助，克服语言、文化和其他传统医疗保健服务的障碍。他们可以提供自主支持并解决与药物依从性障碍相关的问题。此外，健康促进者可以通过改善药物获取、协助提供者的连续性护理、监测治疗反应以及加强教育信息来补充药剂师的活动。拟议的研究将确定在基于诊所的药剂师服务中添加健康促进剂是否可以改善护理。该研究将通过芝加哥伊利诺伊大学医学中心招募 300 名糖尿病未得到控制的非裔美国人和拉丁裔成年人，并随机分为两组：(1) 药剂师管理 (Pharm)，为期 12 个月；(2) 药剂师管理 (Pharm)，为期 12 个月。 (2) 在 HP 支持下 (Pharm+HP) 进行为期 12 个月的药剂师管理。交叉将在 12 个月时发生，这样 Pharm 组将通过增加 HP 支持而得到加强，并且 HP 支持将从 Pharm+HP 组中逐步淘汰以评估维护。具体目标包括： (1) 评估 Pharm+HP 与单独 Pharm 相比对糖尿病行为（包括健康饮食、体力活动和药物依从性）、糖化血红蛋白、血压和 LDL-胆固醇水平的有效性； (2) 通过在第 1 年之后逐步取消 Pharm+HP 组的 HP 支持来评估改善的糖尿病行为和临床结果的维持情况； (3) 评估仅 Pharm 一年后添加 HP 所提供的强化； (4) 评估 Pharm+HP 和单独 Pharm 的成本和成本效益。