Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care

被引:8
作者
Ferrer, Robert L. [1 ]
Schlenker, Carolina Gonzalez [1 ]
Cruz, Inez [1 ]
Noel, Polly Hitchcock [1 ]
Palmer, Raymond F. [1 ]
Poursani, Ramin [1 ]
Jaen, Carlos Roberto [1 ]
机构
[1] UT Hlth San Antonio, Long Sch Med, Dept Family & Community Med, San Antonio, TX USA
关键词
community health worker; primary care; self-management; trust; type; 2; diabetes; BLOOD-GLUCOSE CONTROL; GLYCEMIC CONTROL; CONCEPTUAL-FRAMEWORK; SOCIAL DETERMINANTS; CHRONIC DISEASE; CAPABILITY; PREVENTION; MORTALITY; PEOPLE; EQUITY;
D O I
10.1370/afm.2848
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE Improving patients' self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabe-tes mellitus (T2DM).METHODS This cohort study, in a safety-net primary care practice, enrolled patients with uncontrolled T2DM and psychosocial risk factors. Patients were identified through a practice diabetes registry or by clinicians' referrals. The CHWs engaged patients in trust building and sensemaking to understand their social context, identify goals, navigate health care, and connect to community resources. Primary outcome was progress through 3 prospectively defined stages of self-care: outreach (meeting face-to-face); stabilization (collaborating to address patients' life circumstances); and self-care generativity (achieving self-care competencies). Secondary outcomes were change in hemoglobin A1c (HbA1c) and need for urgent care, emergency department, or hospital visits.RESULTS Of 986 participating patients, 27% remained in outreach, 41% progressed to stabilization, and 33% achieved self-care generativity. Repeated measures ANOVA demon-strates an overall decline in HbA1c, without group differences, through the 4th HbA1c mea-surement (mean follow-up 703 days). Beginning at the 5th HbA1c measurement (mean 859 days), the self-care generativity group achieved greater declines in HbA1c, which widened through the 10th measurement (mean 1,365 days) to an average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% in the stabilization group (P = .003). Rates of emergency department and hospital visits were lower in the self-care generativity group.CONCLUSIONS Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.Ann Fam Med 2022;20:438-445. https://doi.org/10.1370/afm.2848
引用
收藏
页码:438 / 445
页数:8
相关论文
共 53 条
  • [11] Using Health Information Technology to Bring Social Determinants of Health into Primary Care: A Conceptual Framework to Guide Research
    Cottrell, Erika K.
    Gold, Rachel
    Likumahuwa, Sonja
    Angier, Heather
    Huguet, Nathalie
    Cohen, Deborah J.
    Clark, Khaya D.
    Gottlieb, Laura M.
    DeVoe, Jennifer E.
    [J]. JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED, 2018, 29 (03) : 949 - 963
  • [12] EFFECT OF REGRESSION TO MEAN IN EPIDEMIOLOGIC AND CLINICAL STUDIES
    DAVIS, CE
    [J]. AMERICAN JOURNAL OF EPIDEMIOLOGY, 1976, 104 (05) : 493 - 498
  • [13] Bending the Trends
    DeSalvo, Karen
    Harris, Andrea
    [J]. ANNALS OF FAMILY MEDICINE, 2017, 15 (04) : 304 - 306
  • [14] Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice
    DeVoe, Jennifer E.
    Bazemore, Andrew W.
    Cottrell, Erika K.
    Likumahuwa-Ackman, Sonja
    Grandmont, Jene
    Spach, Natalie
    Gold, Rachel
    [J]. ANNALS OF FAMILY MEDICINE, 2016, 14 (02) : 104 - 108
  • [15] Pursuing equity: Contact with primary care and specialist clinicians by demographics, insurance, and health status
    Ferrer, Robert L.
    [J]. ANNALS OF FAMILY MEDICINE, 2007, 5 (06) : 492 - 502
  • [16] Measuring Capability for Healthy Diet and Physical Activity
    Ferrer, Robert L.
    Cruz, Inez
    Burge, Sandra
    Bayles, Bryan
    Castilla, Martha I.
    [J]. ANNALS OF FAMILY MEDICINE, 2014, 12 (01) : 46 - 56
  • [17] Advanced Primary Care in San Antonio: Linking Practice and Community Strategies to Improve Health
    Ferrer, Robert L.
    Schlenker, Carolina Gonzalez
    Romero, Raquel Lozano
    Poursani, Ramin
    Bazaldua, Oralia
    Davidson, DeWayne
    Gonzales, Melissa Ann
    DeHoyos, Janie
    Castilla, Martha
    Corona, Betty A.
    Tysinger, James
    Alsip, Bryan
    Trejo, Jonathan
    Jaen, Carlos Roberto
    [J]. JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE, 2013, 26 (03) : 288 - 298
  • [18] Capability and Clinical Success
    Ferrer, Robert L.
    Carrasco, Alejandra Varela
    [J]. ANNALS OF FAMILY MEDICINE, 2010, 8 (05) : 454 - 460
  • [19] From sick role to practices of health and illness
    Frank, Arthur W.
    [J]. MEDICAL EDUCATION, 2013, 47 (01) : 18 - 25
  • [20] Freire Paulo, 1970, Pedagogy of the Oppressed: 30th Year Anniversary Edition, V2017