Implementation, Outcomes, and Lessons Learned From a Collaborative Primary Health Care Program to Improve Diabetes Care Among Urban Latino Populations

Abstract

A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.

A scoping literature review of collaboration between primary care and public health

“…Community activities included community engagement and participation Alexy and Elnitsky, 1996;Billingham and Perkins, 1997; Table 2 Articles included in scoping review listed by first author Alexy and Elnitsky (1996) Elster et al, 2002;Harrison et al, 2006;PHRED, 2006;Wedel et al, 2007;McElmurry et al, 2009), improving quality of care (Ferguson et al, 1992;Alexy and Elnitsky, 1996;Lundeen et al, 1997;Harris et al, 2003;Heller and Goldwater, 2004), containing costs Voelker, 1994; The Committee on Medicine and Public Health, 1997; Welton et al, 1997;Hripcsak et al, 1999;Williams et al, 1999), enhancing evidence-informed practice Jordan et al, 1998;Hopayian et al, 2005;Larson et al, 2006) and improving emergency planning and response (Hogg et al, 2006b;Harris et al, 2007;Mack et al, 2007;Pierce et al, 2007;Taylor et al, 2007). Collaboration was, however, also negatively impacted by the rapid and constant change created by healthcare reform Hopayian et al, 2005).…”

Implementing an electronic health record as an objective measure of care provider accountability for a resource-poor rural area in the Dominican Republic

“…customs, medical practices, folk remedies, etc. ), demographics, and politics is essential for a productive project outcome [34][35][36][37][38][39][40][41][42].…”

Reducing Diabetes Disparities Through the Implementation of a Community Health Worker–Led Diabetes Self-Management Education Program

“…16 Patients with chronic disease have reported that they need to better understand their condition in order to appropriately manage it and that CHWs need to be effective communicators and respectful of the patient. 27 The DEP leadership sought to meet these patient needs through focused recruitment of CHWs within the targeted communities and extensive team-based training.…”

“…15 Community health workers can provide time-intensive and community-based diabetes self-training and can serve as a bridge between patients and providers. 11,16 Patients are more likely to trust a peer from a similar background who understands the patient's culture. 16 This level of trust allows patients and CHWs to work together to improve diabetes-specific behaviors.…”

“…11,16 Patients are more likely to trust a peer from a similar background who understands the patient's culture. 16 This level of trust allows patients and CHWs to work together to improve diabetes-specific behaviors. 4 Community health workers can coach patients on effective communication with health care providers, explain concepts and answer questions, and provide emotional support and a level of care coordination.…”