OBJECTIVE -To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes. RESEARCH DESIGN AND METHODS-This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n ϭ 30 patients), provider education only (PROV group) (n ϭ 38), and usual care (UC group) (n ϭ 51).RESULTS -A marked decline in HbA 1c was observed in the CCM group (Ϫ0.6%, P ϭ 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P ϭ 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: Ϫ10.4 mg/dl, P ϭ 0.24; self-monitor blood glucose: ϩ22.2%, P Ͻ 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P ϭ 0.05; self-monitor blood glucose: P ϭ 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (ϩ5.5 mg/dl, P ϭ 0.0004), diabetes knowledge test scores (ϩ6.7%, P ϭ 0.07), and empowerment scores (ϩ2, P ϭ 0.02).CONCLUSIONS -These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes. Diabetes Care 29:811-817, 2006D iabetes affects ϳ7% of the U.S. population and has reached epidemic proportions (1). Diabetes represents a significant public health burden worldwide by decreasing quality of life and causing death and disability at great economic cost (2). Though quality diabetes care is essential to prevent long-term complications, care often falls below recommended standards regardless of health care setting or patient population, emphasizing the necessity for system change (3-6).The chronic care model (CCM) (3,4,7,8) is a multifaceted framework for enhancing health care delivery. The model is based on a paradigm shift from the current model of dealing with acute care issues to a system that is prevention based (3,5,(7)(8)(9). The premise of the model is that quality diabetes care is not delivered in isolation and can be enhanced by community resources, selfmanagement support, delivery system redesign, decision support, clinical information systems, and organizational support working in tandem to enhance patient-provider interactions (3,4,7-13). Currently, few efforts exist to implement multifaceted approaches to improve quality of care in diabetes despite studies that demonstrate their proven effectiveness (3,4,11,14,15).The objective of the current study was to determine the effectiveness of an intervention based on the CCM in primary care settings. We hypothesized that patient clinical (glycemic, blood pressure, and lipid control), behavioral (selfmonitoring of blood glucose), psychological/psychosocial (qualit...

Background: Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000-2004 and the effects and possible interactions between the public health interventions in use.

The prevalence of cardiovascular diseases has been shown to be on the increase in Africa based on hospital-based information and limited national surveys. A recent report on analysis of data from Health Information Management Systems (HIMS) highlighted an increasing burden of noncommunicable diseases (NCDs) in Eritrea, with the incidence of hypertension doubling in a space of 6 years. HMIS data are only a proxy of national prevalence rates, necessitating the conduct of national surveys. The WHO STEPwise approach to surveillance of NCDs was used for the national NCD risk factor survey in 2004. This report focuses on blood pressure (BP) and obesity (body mass index (BMI) > 30 kg/m2) as NCD risk factors in Eritrea. A total of 2352 people in age groups 15 to 64 years participated in the survey. The prevalence of hypertension defined as BP > 140/90 mmHg was 15.9% in the general population, with 16.4% in urban and 14.5% in rural areas, 17% of whom were males while 15% were females. BMI was positively associated with systolic (SBP), diastolic and mean arterial pressure. Although the prevalence of obesity (3.3%) was higher in females, the effect of BMI on BP was higher in males than in females (regression coefficient 0.64 and 0.38, respectively, P < or = 0.05), especially in those >45 years. BMI did not have a significant effect on BP in lean people (BMI < 19) and in those with high BMI, but was positively correlated to SBP in those with normal BMI (P < or = 0.02). BMI and age appear to play a synergistic role in creating a strong association with BP.

Background: Communicable diseases are the leading causes of illness, deaths, and disability in sub-Saharan Africa. To address these threats, countries within the World Health Organization (WHO) African region adopted a regional strategy called Integrated Disease Surveillance and Response (IDSR). This strategy calls for streamlining resources, tools, and approaches to better detect and respond to the region's priority communicable disease. The purpose of this study was to analyze the incremental costs of establishing and subsequently operating activities for detection and response to the priority diseases under the IDSR.