PMID- 36228078
OWN - NLM
STAT- MEDLINE
DCOM- 20221017
LR  - 20221222
IS  - 1544-1717 (Electronic)
IS  - 1544-1709 (Print)
IS  - 1544-1709 (Linking)
VI  - 20
IP  - 5
DP  - 2022 Sep-Oct
TI  - Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary 
      Care.
PG  - 438-445
LID - 10.1370/afm.2848 [doi]
AB  - PURPOSE: Improving patients' self-care for chronic disease is often elusive in 
      the context of social deprivation. We evaluated whether a practice-integrated 
      community health worker (CHW) intervention could encourage effective long-term 
      self-management of type 2 diabetes mellitus (T2DM). METHODS: This cohort study, 
      in a safety-net primary care practice, enrolled patients with uncontrolled T2DM 
      and psychosocial risk factors. Patients were identified through a practice 
      diabetes registry or by clinicians' referrals. The CHWs engaged patients in trust 
      building and sensemaking to understand their social context, identify goals, 
      navigate health care, and connect to community resources. Primary outcome was 
      progress through 3 prospectively defined stages of self-care: outreach (meeting 
      face-to-face); stabilization (collaborating to address patients' life 
      circumstances); and self-care generativity (achieving self-care competencies). 
      Secondary outcomes were change in hemoglobin A(1c) (HbA(1c)) and need for urgent 
      care, emergency department, or hospital visits. RESULTS: Of 986 participating 
      patients, 27% remained in outreach, 41% progressed to stabilization, and 33% 
      achieved self-care generativity. Repeated measures ANOVA demonstrates an overall 
      decline in HbA(1c), without group differences, through the 4th HbA(1c) 
      measurement (mean follow-up 703 days). Beginning at the 5th HbA(1c) measurement 
      (mean 859 days), the self-care generativity group achieved greater declines in 
      HbA(1c), which widened through the 10th measurement (mean 1,365 days) to an 
      average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% 
      in the stabilization group (P = .003). Rates of emergency department and hospital 
      visits were lower in the self-care generativity group. CONCLUSIONS: 
      Practice-linked CHWs can sustainably engage vulnerable patients, helping them 
      advance self-management goals in the context of formidable social disadvantage.
CI  - (c) 2022 Annals of Family Medicine, Inc.
FAU - Ferrer, Robert L
AU  - Ferrer RL
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas FerrerR@uthscsa.edu.
FAU - Schlenker, Carolina Gonzalez
AU  - Schlenker CG
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
FAU - Cruz, Inez
AU  - Cruz I
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
FAU - Noel, Polly Hitchcock
AU  - Noel PH
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
FAU - Palmer, Raymond F
AU  - Palmer RF
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
FAU - Poursani, Ramin
AU  - Poursani R
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
FAU - Jaen, Carlos Roberto
AU  - Jaen CR
AD  - Department of Family and Community Medicine, Long School of Medicine, UT Health 
      San Antonio, San Antonio, Texas.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Fam Med
JT  - Annals of family medicine
JID - 101167762
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - Cohort Studies
MH  - *Community Health Workers
MH  - *Diabetes Mellitus, Type 2/therapy
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Primary Health Care
MH  - Self Care
MH  - Trust
PMC - PMC9512562
OTO - NOTNLM
OT  - community health worker
OT  - primary care
OT  - self-management
OT  - trust
OT  - type 2 diabetes
EDAT- 2022/10/14 06:00
MHDA- 2022/10/18 06:00
PMCR- 2022/09/01
CRDT- 2022/10/13 14:23
PHST- 2021/08/24 00:00 [received]
PHST- 2022/02/08 00:00 [revised]
PHST- 2022/05/10 00:00 [accepted]
PHST- 2022/10/13 14:23 [entrez]
PHST- 2022/10/14 06:00 [pubmed]
PHST- 2022/10/18 06:00 [medline]
PHST- 2022/09/01 00:00 [pmc-release]
AID - 20/5/438 [pii]
AID - 10.1370/afm.2848 [doi]
PST - ppublish
SO  - Ann Fam Med. 2022 Sep-Oct;20(5):438-445. doi: 10.1370/afm.2848.