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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial.

ABSTRACT: OBJECTIVES:To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS:In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS:Similar HbA1C declines were noted after receiving the 1 year of CHW support: -0.45% (95% confidence interval [CI] -0.96 to 0.05) with CHW versus -0.42% (95% CI -0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI -1.92 to 3.53) with CHW versus -1.85 mm Hg (95% CI -4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS:No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.

SUBMITTER: Sharp LK

PROVIDER: S-EPMC5766435 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial.

Sharp Lisa K LK Tilton Jessica J JJ Touchette Daniel R DR Xia Yinglin Y Mihailescu Daniel D Berbaum Michael L ML Gerber Ben S BS

Pharmacotherapy 20171130 1

<h4>Objectives</h4>To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population.<h4>Methods</h4>In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A<sub>1c</sub> [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical ph ...[more]

PMID: 29121408

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Project description:To undertake the first randomized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking.This parallel group randomized trial allocated participants individually to brief alcohol intervention (n?=?205) or a leaflet-only control condition (n?=?202), with follow-up study after 3 months.Sixteen community pharmacies in one London Borough, UK.A total of 407 pharmacy customers (aged 18?years or over) with Alcohol Use Disorder Identification Test (AUDIT) scores 8-19, inclusive.A brief motivational discussion of approximately 10 minutes' duration, for which 17 pharmacists received a half-day of training.Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a researcher blind to allocation status. The two primary outcomes were: (1) change in AUDIT total scores and (2) the proportions no longer hazardous or harmful drinkers (scoring <?8) at 3?months. The four secondary outcomes were: the three subscale scores of the AUDIT (for consumption, problems and dependence) and health status according to the EQ-5D (a standardized instrument for use as a measure of health outcome).At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed-up. The difference in reduction in total AUDIT score (intervention minus control) was -0.57, 95% confidence interval (CI)?=?-1.59 to 0.45, P?=?0.28. The odds ratio for AUDIT ??8 (control as reference) was 0.87, 95% CI?=?0.50 to 1.51, P?=?0.61). For two of the four secondary outcomes (dependence score: -0.46, 95% CI?=?-0.82 to -0.09, P?=?0.014; health status score: -0.09, 95% CI?=?-0.16 to -0.02, P?=?0.013) the control group did better, and in the other two there were no differences (consumption score: -0.05, 95% CI?=?-0.54 to 0.44, P?=?0.85; non-dependence problems score: -0.13, 95% CI?=?-0.66 to 0.41). Sensitivity analyses did not change these findings.A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.

Project description:BackgroundCambodian Americans have high rates of cardiometabolic and psychiatric disorders and disadvantaged social determinants of health (SDOH). These factors can make it challenging to resolve drug therapy problems (DTPs) and improve medication-related outcomes. This manuscript reports planned analyses from a randomized controlled trial in which participants were randomized to one of 3 treatment arms: (1) community health worker (CHW)-delivered lifestyle intervention called Eat, Walk, sleep (EWS), (2) EWS plus pharmacist/CHW-delivered medication therapy management (EWS + MTM), or (3) social services (SS: control).ObjectivesWe compared the 3 arms on changes in self-reported medication adherence, barriers, and beliefs. Within the EWS + MTM arm only, we assessed the impact of EWS + MTM on DTP resolution and examined predictors of DTP resolution.MethodsCambodian Americans at the age of 35-75 years at high risk of developing diabetes and meeting the criteria for likely depression (N = 188) were randomized (EWS, n = 67; EWS + MTM, n = 63; SS, n = 50; control). For all participants, self-reported surveys were collected at baseline, 12 months, and 15 months. DTPs were assessed on the same schedule but only for participants in the EWS + MTM.ResultsAll 3 groups reported a significant decrease in barriers to taking medications. Compared with the other arms, the EWS + MTM arm reported a decrease in forgetting to take medications at 15 months. In the EWS + MTM arm, mean DTPs per patient was 6.57 and 84% of DTPs were resolved. SDOH predictors of DTP resolution included years of education (odds ratio [OR] 0.94, P = 0.016), ability to write English (OR 0.73, P = 0.015), difficulty communicating with provider (OR 1.39, P < 0.001), private insurance (OR 1.99, P = 0.030), disability (OR 0.51, P = 0.008), and years living under Pol Pot (OR 0.66, P = 0.045). Medication barriers at baseline predicted DTP resolution (OR 0.79, P = 0.019) such that each additional barrier was associated with a 21% reduction (1-0.79) in the odds of having a resolution.ConclusionCHWs can reduce medications barriers and help pharmacists reduce DTPs in disadvantaged populations.

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial.

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial.

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