Scientific Evidence

A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness

Piette J, Resnicow K, Choi H, Heisler M

In a randomized trial, a guided diabetes peer support intervention improved glycemic control (A1c), with a difference in A1c change between groups of 0.58% (p = 0.004). The current study examined whether improvements in insulin uptake and perceived diabetes social support mediated the intervention’s impact on A1c. The investigators also examined potential moderation by patients’ health literacy, diabetes social support, or diabetes distress.

Secondary analyses were conducted for 212 type 2 diabetes patients participating in the trial using accepted methods for testing mediation and moderation effects.

Roughly half (49%, 95% CI: 3-80%) of the A1c effect was mediated by increased insulin use, while changes in diabetes social support had a negligible impact. A1c impacts varied across subgroups defined by baseline diabetes social support and functional health literacy (both p < 0.01). The intervention was particularly beneficial among patients with low baseline diabetes support or literacy levels. The intervention had a greater impact on A1c among patients with more frequent engagement in peer support calls (p < 0.01).

Patients receiving increased peer support had improved glycemic control largely due to their greater likelihood of initiating insulin. Greater intervention engagement was associated with stronger effects. The intervention had its greatest benefits among patients with low support or poorer health literacy.

Chronic Illness; Apr 12 [Full Abstract]

Advanced primary care in San Antonio: linking practice and community strategies to improve health

Ferrer RL, Gonzalez Schlenker C, Lozano Romero R, Poursani R, Bazaldua O, Davidson D, Ann Gonzales M, Dehoyos J, Castilla M, Corona BA, Tysinger J, Alsip B, Trejo J, Jaén CR

This article describes an emerging community of solution to improve health outcomes for a population of 6000 residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses.

Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores (community health workers) whose mission encompasses change at both the individual and community levels. Centered on patients’ functional goals, promotores mobilize family and community resources and consider what community-level action will address the social determinants of health. On the clinical side, care teams implement population-based risk assessment and nurse care management with a focus on care transitions as well as other measures to meet the needs of patients with high morbidity and high use of health care.

Population-based outcome metrics include reductions in hospitalizations, emergency department and urgent care visits, and the associated charges. Promotores also assess patients’ progress along the trajectory of their selected functional goals.

Journal of the American Board of Family Medicine; May-Jun;26(3):288-98 [Full Article]

Development, Implementation, and Preliminary Evaluation of a Recovery-Based Curriculum for Community Navigation Specialists Working with Individuals with Serious Mental Illnesses and Repeated Hospitalizations

Compton MT, Reed T, Broussard B, Powell I, Thomas GV, Moore A, Cito K, Haynes N

A recovery-oriented curriculum for training the Community Navigation Specialists (CNSs) of the new Opening Doors to Recovery in Southeast Georgia program was developed, implemented, and preliminarily evaluated. This new mental health program provides mobile, community-based support services to individuals with serious mental illnesses and a history of psychiatric inpatient recidivism (and commonly past incarcerations and homelessness). Teams of CNSs include a licensed social worker, a family member of an individual with a serious mental illness, and a peer specialist with lived experience.

In two courses held in February and June of 2011, 14 newly hired CNSs participated in the new training. A pre-training/post-training evaluation demonstrated statistically significant improvements in pertinent knowledge and self-efficacy for working in a community navigation role. As the recovery paradigm continues to be implemented in diverse real-world mental health treatment settings, recovery-based training curricula should be carefully constructed and evaluated.

Community Mental Health Journal; March 2013 [Full Abstract]