Mentored implementation to initiate a diabetes program in an underserved community: a pilot study
Introduction Community clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-support...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002320.full |
| _version_ | 1819292166982205440 |
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| author | Salim S Virani Ashok Balasubramanyam Christie M Ballantyne Aanand D Naik Elizabeth M Vaughan Amber B Amspoker Craig A Johnston Joshua D Landrum John P Foreyt |
| author_facet | Salim S Virani Ashok Balasubramanyam Christie M Ballantyne Aanand D Naik Elizabeth M Vaughan Amber B Amspoker Craig A Johnston Joshua D Landrum John P Foreyt |
| author_sort | Salim S Virani |
| collection | DOAJ |
| description | Introduction Community clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic.Research design and methods Participants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.Results Phase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: −0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (p<0.001–0.002). Phase II: participants had significant reductions in HbA1c (mean change: −0.78%, p=0.006), diastolic blood pressure (p=0.004), body mass index (0.012), weight (p=0.010), medication non-adherence (p<0.001), and six ADA measures (p=0.007–0.005). Phase I intervention versus phase II outcomes were comparable. CHWs improved knowledge from pre-test to post-tests (p<0.001).Conclusions A novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics. |
| first_indexed | 2024-12-24T03:50:13Z |
| format | Article |
| id | doaj.art-e5995381879c40469b59bfbc91968aaa |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-12-24T03:50:13Z |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-e5995381879c40469b59bfbc91968aaa2022-12-21T17:16:37ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-10-019110.1136/bmjdrc-2021-002320Mentored implementation to initiate a diabetes program in an underserved community: a pilot studySalim S Virani0Ashok Balasubramanyam1Christie M Ballantyne2Aanand D Naik3Elizabeth M Vaughan4Amber B Amspoker5Craig A Johnston6Joshua D Landrum7John P Foreyt8Department of Medicine, Baylor College of Medicine, Houston, Texas, USADepartment of Medicine, Baylor College of Medicine, Houston, Texas, USADepartment of Medicine, Baylor College of Medicine, Houston, Texas, USADepartment of Medicine, Baylor College of Medicine, Houston, Texas, USADepartment of Medicine, Baylor College of Medicine, Houston, Texas, USAHealth Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center, Houston, Texas, USADepartment of Health and Human Performance, University of Houston, Houston, Texas, USASchool of Health Professions, Baylor College of Medicine, Houston, Texas, USADepartment of Medicine, Baylor College of Medicine, Houston, Texas, USAIntroduction Community clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic.Research design and methods Participants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.Results Phase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: −0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (p<0.001–0.002). Phase II: participants had significant reductions in HbA1c (mean change: −0.78%, p=0.006), diastolic blood pressure (p=0.004), body mass index (0.012), weight (p=0.010), medication non-adherence (p<0.001), and six ADA measures (p=0.007–0.005). Phase I intervention versus phase II outcomes were comparable. CHWs improved knowledge from pre-test to post-tests (p<0.001).Conclusions A novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.https://drc.bmj.com/content/9/1/e002320.full |
| spellingShingle | Salim S Virani Ashok Balasubramanyam Christie M Ballantyne Aanand D Naik Elizabeth M Vaughan Amber B Amspoker Craig A Johnston Joshua D Landrum John P Foreyt Mentored implementation to initiate a diabetes program in an underserved community: a pilot study BMJ Open Diabetes Research & Care |
| title | Mentored implementation to initiate a diabetes program in an underserved community: a pilot study |
| title_full | Mentored implementation to initiate a diabetes program in an underserved community: a pilot study |
| title_fullStr | Mentored implementation to initiate a diabetes program in an underserved community: a pilot study |
| title_full_unstemmed | Mentored implementation to initiate a diabetes program in an underserved community: a pilot study |
| title_short | Mentored implementation to initiate a diabetes program in an underserved community: a pilot study |
| title_sort | mentored implementation to initiate a diabetes program in an underserved community a pilot study |
| url | https://drc.bmj.com/content/9/1/e002320.full |
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