Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial.

Autor:	Tang TS; University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada tricia.tang@vch.ca., Funnell M; University of Michigan Department of Medical Education, Ann Arbor, MI., Sinco B; University of Michigan School of Social Work, Ann Arbor, MI., Piatt G; University of Michigan Department of Medical Education, Ann Arbor, MI., Palmisano G; Community Health and Social Services Center, Detroit, MI., Spencer MS; University of Michigan School of Social Work, Ann Arbor, MI., Kieffer EC; University of Michigan School of Social Work, Ann Arbor, MI., Heisler M; University of Michigan Department of Internal Medicine, Ann Arbor, MIAnn Arbor VA Center for Clinical Management Research, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2014 Jun; Vol. 37 (6), pp. 1525-34. Date of Electronic Publication: 2014 Apr 10.
DOI:	10.2337/dc13-2161
Abstrakt:	Objective: To compare a peer leader (PL) versus a community health worker (CHW) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education (DSME) program. Research Design and Methods: One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and randomized to (1) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or (2) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs. The primary outcome was HbA1c. Secondary outcomes were cardiovascular disease risk factors, diabetes distress, and diabetes social support. Assessments were conducted at baseline, 6, 12, and 18 months. Results: After DSME, the PL group achieved a reduction in mean HbA1c (8.2-7.5% or 66-58 mmol/mol, P < 0.0001) that was maintained at 18 months (-0.6% or -6.6 mmol/mol from baseline [P = 0.009]). The CHW group also showed a reduction in HbA1c (7.8 vs. 7.3% or 62 vs. 56 mmol/mol, P = 0.0004) post-6 month DSME; however, it was attenuated at 18 months (-0.3% or -3.3 mmol/mol from baseline, within-group P = 0.234). Only the PL group maintained improvements achieved in blood pressure at 18 months. At the 18-month follow-up, both groups maintained improvements in waist circumference, diabetes support, and diabetes distress, with no significant differences between groups. Conclusions: Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes, but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months. (© 2014 by the American Diabetes Association.)
Databáze:	MEDLINE
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