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Prev Chronic Dis. 2017 Feb 9;14:E15. doi: 10.5888/pcd14.160344.

Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014.

Author information

1
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.
2
VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.
3
University of Washington, School of Medicine, Seattle, Washington.
4
University of Washington, School of Public Health, Seattle, Washington.
5
Public Health - Seattle and King County, Seattle, Washington.

Abstract

INTRODUCTION:

Community health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes.

METHODS:

Low-income patients with glycated hemoglobin A1c (HbA1c) of 8.0% or higher in the 12 months before enrollment from 3 safety-net providers were randomized to a 12-month CHW-delivered diabetes self-management intervention or usual care. CHWs were based at a local health department. The primary outcome was change in HbA1c from baseline enrollment to 12 months; secondary outcomes included blood pressure and lipid levels, quality of life, and health care use.

RESULTS:

The change in HbA1c in the intervention group (n = 145) (unadjusted mean of 9.09% to 8.58%, change of -0.51) compared with the control group (n = 142) (9.04% to 8.71%, change of -0.33) was not significant (P = .54). In an analysis of participants with poor glycemic control (HbA1c >10%), the intervention group had a 1.23-point greater decrease in HbA1c compared with controls (P = .046). For the entire study population, we found a decrease in reported physician visits (P < .001) and no improvement in health-related quality of life (P = .07) in the intervention group compared with the control group.

CONCLUSION:

A low-intensity CHW-delivered intervention to support diabetes self-management did not significantly improve HbA1c relative to usual care. Among the subgroup of participants with poor glycemic control (HbA1c >10% at baseline), the intervention was effective.

PMID:
28182863
PMCID:
PMC5303652
DOI:
10.5888/pcd14.160344
[Indexed for MEDLINE]
Free PMC Article

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