scholarly journals Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Letizia Trevisi ◽  
John E. Orav ◽  
Sidney Atwood ◽  
Christian Brown ◽  
Cameron Curley ◽  
...  
Keyword(s):  
Community Health ◽  
Clinical Outcomes ◽  
Glycosylated Hemoglobin ◽  
Density Lipoprotein ◽  
Community Outreach ◽  
Trial Registration ◽  
Navajo Nation ◽  
Difference In Differences ◽  
Community Health Representatives ◽  
The Impact

Abstract Background We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. Methods We abstracted routine clinical data from the Indian Health Service’s information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. Results Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (− 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (− 10.58 mg/dl) compared to the non-COPE group (− 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. Conclusion Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. Trial registration Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.

Health Literacy in Dentistry and Navajo Nation Community Health Representatives

2016 ◽  
Vol 6 (6) ◽  
Author(s):  
Steven P. Geiermann ◽  
◽  
Mae-Gilene Begay ◽  
Lindsey Robinson ◽  
Sharon Clough ◽  
...  
Keyword(s):  
Health Literacy ◽  
Community Health ◽  
Navajo Nation ◽  
Community Health Representatives

scholarly journals Effect of intermittent versus continuous calorie restriction on body weight and cardiometabolic risk markers in subjects with overweight or obesity and mild-to-moderate hypertriglyceridemia: a randomized trial

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Mahsa Maroofi ◽  
Javad Nasrollahzadeh
Keyword(s):  
Body Weight ◽  
Calorie Restriction ◽  
Density Lipoprotein ◽  
The Body ◽  
Trial Registration ◽  
Lipoprotein Cholesterol ◽  
Short Term ◽  
Significant Difference ◽  
The Impact ◽  
Overweight Or Obesity

Abstract Background Intermittent calorie restriction (ICR) is a novel method of dietary restriction for body weight control with the potential to improve obesity-related cardiometabolic markers, but the impact of this diet on subjects with hypertriglyceridemia (HTG) remains unknown. Methods Eighty-eight subjects with overweight or obesity and mild-to-moderate HTG were randomized to the continuous calorie restriction (CCR) group, or ICR group (a very low-calorie diet during 3 days of the week) for 8 weeks (44 patients in each group). Body composition, plasma lipids, glucose, insulin, adiponectin, and liver enzymes were measured at baseline and after 8 weeks. An intention-to-treat analysis was performed. Results The body weight decreased in both groups (4.07 ± 1.83 kg in the CCR group and 4.57 ± 2.21 kg in the ICR group) with no significant difference between the groups. There was no significant difference between the two groups in the reduced amount of fat mass, fat-free mass, and waist circumference. Both groups achieved a significant reduction in plasma triglycerides after 8 weeks (by 15.6 and 6.3% in ICR and CCR groups, respectively) with no difference between treatment groups. HOMA-IR improved significantly in ICR compared to the CCR group (P = 0.03). Plasma glucose, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, liver enzyme, and adiponectin were not different between the two groups. Conclusions The results of this short-term study suggest that three-days a week of the ICR is comparable to a CCR diet for the reduction of triglycerides level in patients with HTG and in the short-term it appears to be more effective than continuous dieting in improving insulin resistance. However, longer-term studies are needed to confirm these findings. Trial registration Trial registration number:NCT04143971.

scholarly journals Implementation Fidelity of a Complex Behavioral Intervention to Prevent Diabetes Mellitus in Two Safety Net Patient-Centered Medical Homes in New York City

2021 ◽  
Author(s):  
Avni Gupta ◽  
Jiyuan Hu ◽  
Shengnan Huang ◽  
Laura Diaz ◽  
Radhika Gore ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Community Health ◽  
Goal Setting ◽  
Behavioral Intervention ◽  
Complex Interventions ◽  
Implementation Fidelity ◽  
Safety Net ◽  
Trial Registration ◽  
Fidelity Assessment ◽  
The Impact

Abstract BackgroundIt is critical to assess implementation fidelity for complex interventions to understand the reasons for their success or failure. However, few interventions systematically report implementation evaluation. Therefore, we conducted a concurrent process evaluation of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW) led, health coaching intervention on preventing incident type 2 Diabetes Mellitus (DM). MethodsThe study population included primary care (PC) patients with prediabetes at 2 safety-net hospitals - VA NY Harbor and Bellevue (BH). PC teams were randomized to receive the one-year intervention or usual care. Of the 559 patients in the intervention group to date, 79.4% completed an intake survey, constituting the analytic sample for fidelity assessment. The Conceptual Framework for Implementation Fidelity (CFIF) was applied to measure implementation fidelity and factors moderating fidelity of four core intervention components: patient goal setting, education topic coaching, PC visits, and referrals to address social determinants of health, using descriptive statistics and regression models.ResultsBH contributed 60.0% of the sample and VA contributed 40.0%. Content adherence was high for three components with nearly 80.0% of patients setting >1 goal, having >1 PC visit and receiving coaching on >1 education topic. Only 45.0% patients received >1 referral. After adjusting for patient gender, language, race, ethnicity, and age, the study site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA). ConclusionsThe CFIF enabled analysis of implementation fidelity of a complex, behavioral intervention. The fidelity of CHORD implementation varied across its four components and was moderated by site. Despite implementation in a research setting, interventions may not completely adhere to their core components, which can influence outcomes. Our study emphasizes the importance of examining implementation fidelity of interventions and of assessing moderating factors. Our study also empirically tested the CFIF using quantitative concurrent intervention fidelity evaluation.Trial registration: The trial was registered with ClinicalTrials.gov on 12/30/2016 and the registration number is NCT03006666. The link to trial registration is: https://clinicaltrials.gov/ct2/show/NCT03006666

scholarly journals Evaluating the Impact of Outpatient Multi-Dose Medication Packaging Service (MDMPS) on Medication Adherence and Clinical Outcomes

2020 ◽  
Vol 11 ◽  
pp. 215013272096508
Author(s):  
Pratibha Nair ◽  
Kok Wai Kee ◽  
Choon Siong Mah ◽  
Eng Sing Lee
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Medication Possession Ratio ◽  
Density Lipoprotein ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Standard Medication ◽  
The Impact

Background: There is limited understanding on the impact of the multidose medication packaging service (MDMPS). Objectives: The main objective of this study was to evaluate changes in medication adherence in patients using MDMPS compared to patients receiving standard medication packaging (control group). The other objectives were to determine the association between medication adherence and clinical outcomes, and to assess patients’/caregivers’ perceptions toward MDMPS. Methods: A retrospective cohort study was conducted among primary care patients in Singapore enrolled into MDMPS between 2012 and 2017. Eligible patients were taking at least five chronic medications, diagnosed with Hypertension, Hyperlipidemia and/or Type 2 Diabetes, with prescription records for at least six months before and after the index period. They were matched to control patients based on the type of comorbidities and medication adherence status. Medication Possession Ratio (MPR), glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-C) of both groups were compared between baseline and at least six months post-index period. Interviewer-administered questionnaires were also conducted for MDMPS patients. Results: The MPR of MDMPS patients (n = 100) increased by 0.37% ( P < .001) compared to the control group (n = 100). MDMPS patients with diabetes had reduced HbA1c by 0.1% after six months ( P = .022) but was not significant after 12 months. No significant changes were seen in blood pressure and LDL-C between both groups. At least 50% of patients were highly satisfied with MDMPS. Conclusion: MDMPS can improve medication adherence. Further studies are needed to understand its clinical impact.

scholarly journals Community–clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e031794
Author(s):  
Christian Brown ◽  
Amber Lalla ◽  
Cameron Curley ◽  
Caroline King ◽  
Olivia Muskett ◽  
...  
Keyword(s):  
Community Health ◽  
Health Workers ◽  
Patient Empowerment ◽  
Healthcare Providers ◽  
Formal System ◽  
Community Outreach ◽  
Advisory Panel ◽  
Navajo Nation ◽  
Provider Perspectives ◽  
The Usa

ObjectiveTo understand providers’ opinions about the Community Outreach and Patient Empowerment (COPE) Project designed to strengthen Navajo Community Health Representative (CHR) outreach to individuals living with diabetes.DesignThis was a qualitative study nested within a larger evaluation of a programme intervention.SettingThe study took place in Navajo Nation and evaluated a programme initiative designed to strengthen collaboration between CHRs and clinic-based healthcare providers and provide structured outreach to individuals living with diabetes in Navajo Nation. The CHR Programme is a formal community health worker programme that exists in most tribal healthcare systems across the USA.ParticipantsHealthcare providers involved in the programme took part in one-on-one interviews.AnalysisWe used thematic analysis for this study. A team of three study staff used open-coding to create a codebook. Coded material were summarised and patterns were identified and tied into a narrative using concept mapping. The study design and instrument construction were guided by a Community Health Advisory Panel.ResultsA total of 13 interviews were completed. Providers acknowledged CHRs as an asset to the clinical team and were enthusiastic about the COPE coaching materials, mentioning they provided a consistent message to CHRs and the community. Providers that led COPE trainings with CHRs valued the face-to-face time and opportunity to build relationships. Providers (n=4) supported CHRs’ access to electronic health record to record patient visits and streamline referrals. Among their requests were having designated personnel to manage referrals with CHRs and a formal system to record modules CHRs have completed.ConclusionProviders participating in COPE activities valued the work of CHRs and endorsed further strengthening relationships and communication with CHRs. Healthcare programmes should consider systems changes to integrate community health workers into clinic-based teams.Trial registration numberNCT03326206; Results.

scholarly journals Strengthening the role of Community Health Representatives in the Navajo Nation

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Caroline King ◽  
Alex Goldman ◽  
Vikas Gampa ◽  
Casey Smith ◽  
Olivia Muskett ◽  
...  
Keyword(s):  
Community Health ◽  
Navajo Nation ◽  
Community Health Representatives

scholarly journals Patient-centered Pharmacist Care in the Hemodialysis Unit: a quasi-experimental interrupted time series study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sherine Ismail ◽  
Abrar Al-Subhi ◽  
Eman Youssif ◽  
Medhat Ahmed ◽  
Abdullah Almalki ◽  
...  
Keyword(s):  
Glycosylated Hemoglobin ◽  
Density Lipoprotein ◽  
Median Number ◽  
Serum Phosphate ◽  
Self Report ◽  
Post Intervention ◽  
Patient Centered ◽  
Medication Therapy ◽  
The Impact ◽  
Pharmacist Care

Abstract Background Nonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes. Limited data exist to demonstrate the effect of incorporating patient-centered interventions using concepts of medication therapy management and motivational interview by pharmacists on pharmacoadherence in patients requiring HD. Therefore, we assessed the impact of patient-centered pharmacist care on pharmacoadherence and its outcomes in patients requiring HD. Methods Adult patients who had received outpatient HD for at least 3 months were enrolled. The study was conducted from October 2016 to April 2017. Pharmacists interviewed the patients at month 1, 2, 4 and 6, and the intervention (comprehensive review) occurred at months 3 and 5. The primary outcome was the change in pharmacoadherence as assessed by pre-HD serum phosphate levels and the differences in the number of medications between patient’ self-report and medications records at the electronic healthcare records (EHRs). The secondary outcomes included changes in systolic blood pressure (SBP), glycosylated hemoglobin levels, serum low-density lipoprotein (LDL) levels, and the prevalence and types of medication-related problems (MRPs). Results Seventy-two patients were enrolled. Their median age was 59 (interquartile range: 47–67.5) years, and 53% were men. Pre- and post-intervention pharmacoadherence, as indicated by serum phosphate levels and the differences in the number of medications between patient’ self-report and the medication records at the EHRs, did not significantly differ (p = 0.682 and 0.348, respectively). Mean SBP and mean LDL did not significantly change post-intervention. The median number of MRPs declined between Months 3 and 5 (p = 0.002): the prevalence of MRPs at Month 3 was 44.9% (95 confidence interval [CI]: 40.4–49.3) and decreased to 29.8% (95 CI: 25.6–34.3) at Month 5. Drug use without indication was the most frequent MRP (23.9%). Conclusions Patient-centered pharmacist care did not result in significant changes in pharmacoadherence. However, its clinical utility as a tool to identify and mitigate MRPs in patients requiring HD is indisputable. Trial Registration ClinicalTrials.gov identifier: NCT03576404 (retrospectively registered on July 3rd, 2018).

scholarly journals The Impact of Glucocorticoid Replacement Regimens on Metabolic Outcome and Comorbidity in Hypopituitary Patients

2006 ◽  
Vol 91 (10) ◽  
pp. 3954-3961 ◽  
Author(s):  
Helena Filipsson ◽  
John P. Monson ◽  
Maria Koltowska-Häggström ◽  
Anders Mattsson ◽  
Gudmundur Johannsson
Keyword(s):  
Body Mass Index ◽  
Total Cholesterol ◽  
Body Mass ◽  
Metabolic Response ◽  
Glycosylated Hemoglobin ◽  
Density Lipoprotein ◽  
Gh Treatment ◽  
Igf I ◽  
Before And After ◽  
The Impact

Abstract Background: Hypopituitary patients with untreated GH deficiency and patients on inappropriately high doses of glucocorticoid (GC) share certain clinical features. Objective: The aim of the study was to examine the influence of GC substitution on clinical characteristics in hypopituitary patients before and after GH replacement therapy. Method: A total of 2424 hypopituitary patients within the KIMS (Pfizer International Metabolic Database) were grouped according to ACTH status. Comparisons were performed between subjects on hydrocortisone (HC) (n = 1186), cortisone acetate (CA) (n = 487), and prednisolone/dexamethasone (n = 52), and ACTH-sufficient patients (AS) (n = 717) before and after 1 yr of GH treatment in terms of body mass index, waist and hip circumference, blood pressure, glucose, glycosylated hemoglobin (HbA1c), serum lipids, IGF-I, and comorbidity. Hydrocortisone equivalent (HCeq) doses were calculated, and measurements were adjusted for sex and age. Results: At baseline, the HC group had increased total cholesterol, triglycerides, waist circumference, and HbA1c, and the prednisolone/dexamethasone group had increased waist/hip ratio as compared with AS. After HCeq dose adjustment, the HC group retained higher HbA1c than the CA group. GC-treated patients showed a dose-related increase in serum IGF-I, body mass index, triglycerides, low-density lipoprotein cholesterol and total cholesterol levels. Subjects with HCeq doses less than 20 mg/d (n = 328) at baseline did not differ from AS in metabolic endpoints. The 1-yr metabolic response to GH was similar in all GC groups and dose categories. All new cases of diabetes (n = 12), stroke (n = 8), and myocardial infarction (n = 3) during GH treatment occurred in GC-treated subjects. Conclusion: HCeq doses of at least 20 mg/d in adults with hypopituitarism are associated with an unfavorable metabolic profile. CA replacement may have metabolic advantages compared with other GCs.

Sign in / Sign up

Export Citation Format

Share Document