Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Abstract

Objectives. To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. Methods. We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013–2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. Results. Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: −0.4 vs 0.0; body mass index: −0.3 vs −0.1; cigarettes per day: −5.5 vs −1.3; systolic blood pressure: −1.8 vs −11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs −0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. Conclusions. A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. Trial Registration. clinicaltrials.gov identifier: NCT01900470.

Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

“…Thus, patients should be equipped with the right skillsets for self-care. Various studies identified the need to facilitate self-management and provide adequate support, for example, through community programmes (59)(60)(61)(62)(63)(64)(65)(66). Although healthcare providers might have provided selfmanagement guidelines and support to polyclinic patients, our study found that patients' practices were still affected by their daily activities involving work and the community, as well as their beliefs and physical condition.…”

Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes

“…A face-to-face intervention with CHW's could offer advantages for rural populations compared to telephone support modalities. In several studies, diabetes self-management interventions used a combination of in-person and telephone visits in accordance with patient preferences (Allen et al, 2011;Kangovi et al, 2017;Palmas et al, 2015;Tang et al, 2014). The convenience of either in-home or telephone visits also improved retention compared to travel required for DSME interventions (Lepard et al, 2015).…”

“…In addition, the effects of diabetes self-management interventions on lowering hospital admissions and emergency department visits have been inconsistent (Begum, Ozolins, & Dower, 2011;Lorig et al, 2013;Sacks et al, 2017). A recent randomized controlled trial using a CHW intervention demonstrated significant decreases in hospital admissions but nonsignificant improvements in PAM scores (Kangovi et al, 2017).…”

Advancing Social Prescribing with Implementation Science

“…29 As a result of the implementation research undertaken to adapt the intervention to a new setting, the research team was able to launch both single-and multicenter randomized controlled trials (RCTs) to test the effectiveness of the new intervention. 30,31 Combined, these studies led to the creation of the Penn Center The implementation research examples highlighted here provide insights into how implementation science can support social prescribing's transition from innovative pilot work to sustainable primary care practice. Many other opportunities exist for new research to be conducted in this rapidly evolving field.…”