Diabetes Educators in Safety-Net Practices

Kahn, Linda S.; Glaser, Kathryn; Fox, Chester H.; Patterson, Adam

doi:10.1177/0145721710397385

Cited by 16 publications

(18 citation statements)

References 15 publications

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“…With the onset of patient-centered medical homes, newer models of training and embedding diabetes educators are available, and may offer opportunity for delivering self-management support to patients. 32,33 This study has several limitations. Clinics and not patients were randomized and baseline differences were noted between arms that were accounted for in statistical analyses.…”

Section: Discussionmentioning

confidence: 94%

Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention

et al. 2013

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BACKGROUND:We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. METHODS: A quasi-experimental, clinic-randomized evaluation was conducted at six community health centers from rural, suburban, and urban locations in Missouri between August 2008 and January 2010. In all, 486 adult patients with type 2 diabetes mellitus participated. Clinics were set up to implement either: 1) a clinic-based approach that involved practice re-design to routinely provide brief diabetes education and counseling services, set action-plans, and perform follow-up without additional financial resources [CARVE-IN]; or 2) an outsourced approach where clinics referred patients to a telephone-based diabetes educator for the same services [CARVE-OUT]. The fidelity of each intervention was determined by the number of contacts with patients, self-report of services received, and patient satisfaction. Intervention effectiveness was investigated by assessing patient knowledge, self-efficacy, health behaviors, and clinical outcomes. RESULTS: Carve-out patients received on average 4.3 contacts (SD=2.2) from the telephone-based diabetes educator versus 1.7 contacts (SD=2.0) from the clinic nurse in the carve-in arm (p<0.001). They were also more likely to recall setting action plans and rated the process more positively than carve-in patients (p<0.001). Few differences in diabetes knowledge, self-efficacy, or health behaviors were found between the two approaches. However, clinical outcomes did vary in multivariable analyses; carve-out patients had a lower HbA1c (β= −0.31, 95 % CI −0.56 to −0.06, p=0.02), systolic blood pressure (β=−3.65, 95 % CI −6.39 to −0.90, p=0.01), and low-density lipoprotein (LDL) cholesterol (β=−7.96, 95 % CI −10.08 to −5.83, p<0.001) at 6 months. CONCLUSION: An outsourced diabetes education and counseling approach for community health centers

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Section: Discussionmentioning

confidence: 94%

Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention

et al. 2013

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“…Similar barriers to GE completion have been described by other educators, especially those in underserved settings. 23,24 But even b Hemoglobin A 1c tests were performed at 1 of 2 accredited laboratories using standard high-pressure liquid chromatography assay methods with a CV of 1.14% at an HbA 1c level of 7.5% (HPMG) and a CV of 0.82% at an HbA 1c level of 6.2% (LCF Research/ABQ HP). Hemoglobin A 1c values were log transformed in the analysis and then retransformed back to their original scale (presented as geometric means).…”

Section: Commentmentioning

confidence: 99%

Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes

2011

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“…16 However, for those who are underserved, many do not benefit from DSME 17 due to existing barriers such as language and literacy, health beliefs and cultural considerations, competing obligations, and poor access. [18][19][20][21][22] To address these barriers, the National Institutes of Health created a Clear Communication initiative to establish plain-language approaches to incorporating both cultural respect and new technologies to overcome issues related to low health literacy. 23 Research has identified that low health literacy undermines the comprehension and self-efficacy needed for health self-management.…”

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confidence: 99%