Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results From a Pragmatic Cluster Randomized Controlled Trial.

Autor:	Fortmann AL; Scripps Whittier Diabetes Institute, San Diego, CA., Soriano EC; Scripps Whittier Diabetes Institute, San Diego, CA., Gallo LC; Department of Psychology, San Diego State University, San Diego, CA., Clark TL; San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA., Spierling Bagsic SR; Scripps Whittier Diabetes Institute, San Diego, CA., Sandoval H; Scripps Whittier Diabetes Institute, San Diego, CA., Jones JA; Scripps Whittier Diabetes Institute, San Diego, CA., Roesch S; Department of Psychology, San Diego State University, San Diego, CA., Gilmer T; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA., Schultz J; Neighborhood Healthcare, Escondido, CA., Bodenheimer T; Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA., Philis-Tsimikas A; Scripps Whittier Diabetes Institute, San Diego, CA.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2024 Jul 01; Vol. 47 (7), pp. 1171-1180.
DOI:	10.2337/dc23-2487
Abstrakt:	Objective: This cluster (clinic-level) randomized controlled trial (RCT) compared medical assistant (MA) health coaching (MAC) with usual care (UC) among at-risk adults with type 2 diabetes in two diverse real-world primary care environments: a federally qualified health center (FQHC; Neighborhood Healthcare) and a large nonprofit private insurance-based health system (Scripps Health). Research Design and Methods: A total of 600 adults with type 2 diabetes who met one or more of the following criteria in the last 90 days were enrolled: HbA1c ≥8% and/or LDL cholesterol ≥100 mg/dL and/or systolic blood pressure (SBP) ≥140 mmHg. Participants at MAC clinics received in-person and telephone self-management support from a specially trained MA health coach for 12 months. Electronic medical records were used to examine clinical outcomes in the overall sample. Behavioral and psychosocial outcomes were evaluated in a subsample (n = 300). Results: All clinical outcomes improved significantly over 1 year in the overall sample (P < 0.001). The reduction in HbA1c was significantly greater in the MAC versus UC group (unstandardized Binteraction = -0.06; P = 0.002). A significant time by group by site interaction also showed that MAC resulted in greater improvements in LDL cholesterol than UC at Neighborhood Healthcare relative to Scripps Health (Binteraction = -1.78 vs. 1.49; P < 0.05). No other statistically significant effects were observed. Conclusions: This was the first large-scale pragmatic RCT supporting the real-world effectiveness of MAC for type 2 diabetes in U.S. primary care settings. Findings suggest that this team-based approach may be particularly effective in improving diabetes outcomes in FQHC settings. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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