Behavioral & Mental Health Outcomes For Hispanic Diabetes Patients.

Results from a study presented at the American Diabetes Association’s (ADA) Annual Scientific Sessions demonstrate Hispanic patients with diabetes were more likely to meet ADA Clinical Practice Recommendations in a nurse-directed diabetes management program involving Hispanic community health workers (CHW’s) than under usual clinic care. Study results show an improvement in diabetes process measures, self-management skills and clinical outcomes among Hispanic patients with diabetes enrolled in the Amigos en Salud (“Friends in Health”) program.

The program uses trained lay CHWs to provide a comprehensive health education intervention developed by Pfizer Health Solutions Inc (PHS).

Eliminating health disparities has specific implications for the approximately two million Hispanic Americans suffering from diabetes. The ADA standards of care recommend diagnostic and therapeutic actions to positively affect diabetes measures such as glycemic control and lifestyle modification.

The Amigos en Salud research study was integrated with a nurse-directed diabetes management program (Diabetes Managed Care Program) and showed improvement in clinical, behavioral and mental health outcomes among Hispanic patients with diabetes. The CHWs, or “promotores,” worked with a clinical diabetes nurse and diabetologist to provide culturally appropriate education to patients with diabetes and comorbid depression. Other responsibilities included conducting patient follow-up, facilitating classes and support groups, working with family members and helping connect patients to the health care system and community resources.

“Community health worker models support, not replace, physician- and nurse-directed diabetes care by providing follow-up and social support to patients, helping them overcome cultural, language or behavioral barriers to
treatment,” said Mayer B. Davidson, MD, Professor of Medicine at Charles R. Drew University of Medicine and Science.

“Amigos en Salud validates the concept that Hispanic diabetes patients who learn how to manage their disease and adopt a healthier lifestyle can achieve improved clinical outcomes.” The established Diabetes Managed Care Program (DMCP) developed by Dr. Davidson was implemented within the Los Angeles County Department of Health Services to address the local health disparity issues, where approximately 16 percent of Hispanics have diabetes, almost two times higher than their non-
Hispanic white counterparts. The DMCP uses treatment protocols for nurses to clinically manage patients with diabetes and is based on the ADA standards of care.

Study Results

A total of 109 adult Hispanic patients with type 2 diabetes were enrolled into the research study and monitored for 12 months. After one year, participants achieved lower mean A1c levels (9.6 percent to 6.9 percent, p<0.00001) with 60 percent achieving the ADA recommended goal of <7.0 percent (p<0.00001) and lowered LDL cholesterol (126 mg/dL to 82 mg/dL, p<0.00001) with 83 percent meeting the goal of <100 mg/dL (p<0.00001). Self reported behavioral improvements were also noted in healthy eating (54 percent to 92 percent, p<0.0001) and regular physical activity (52 percent to 84 percent, p<0.0001) with 55 percent reporting cardiovascular physical activity levels (p<0.0001) and improvement in self-reported medication adherence (p<0.01). "Amigos en Salud is a unique example of how an individualized diabetes management approach combined with a mental health focus can help overcome the growing health disparities in the Hispanic community, and as a result, improve both access to and outcomes of diabetes care," said Ken Babamoto, PharmD, MPH, Director, Community Health Initiatives for Pfizer Health Solutions. "The Los Angeles data supports outcomes from similar Amigos en Salud studies that demonstrate the role of CHWs in improving how diabetes care is currently being delivered to underserved patients." For more information at http://pfizerhealthsolutions.com