Evaluating the Impact of Telehealth-Based, Diabetes Medication Training for Community Health Workers on Glycemic Control

Casey N Keegan, Craig A Johnston, Victor J Cardenas Jr, Elizabeth M Vaughan, Casey N Keegan, Craig A Johnston, Victor J Cardenas Jr, Elizabeth M Vaughan

Abstract

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes.

Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes.

Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1-6) and dosing, titration, and emergencies (TEST-2, months 7-12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers.

Results: Participants' (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3-17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training.

Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

Keywords: Community Health Workers; diabetes; education; group visits; telemedicine.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
(Top) (p = 0.002) and TEST-2 (Bottom) (p = 0.0019). CHW: Community Health Worker

References

    1. International Diabetes Federation International Diabetes Atlas-9th Edition. [(accessed on 4 September 2020)]; Available online: .
    1. Centers for Disease Control and Prevention. US Department of Health and Human Services . National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. CDC; Atlanta, GA, USA: 2017.
    1. Chow E.A., Foster H., Gonzalez V., Mclver L. The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations. Clin. Diabetes. 2012;30:130–133. doi: 10.2337/diaclin.30.3.130.
    1. Polonsky W.H., Henry R.R. Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–1307. doi: 10.2147/PPA.S106821.
    1. Kane E.P., Collinsworth A.W., Schmidt K.L., Brown R.M., Snead C.A., Barnes S.A., Fleming N.S., Walton J.W. Improving diabetes care and outcomes with community health workers. Fam. Pract. 2016;33:523–528. doi: 10.1093/fampra/cmw055.
    1. Brown M.T., Bussell J.K. Medication adherence: WHO cares? Mayo Clin. Proc. 2011;86:304–314. doi: 10.4065/mcp.2010.0575.
    1. Babamoto K.S., Sey K.A., Camilleri A.J., Karlan V.J., Catalasan J., Morisky D.E. Improving diabetes care and health measures among hispanics using community health workers: Results from a randomized controlled trial. Health Educ. Behav. 2009;36:113–126. doi: 10.1177/1090198108325911.
    1. Bhaumik S., Moola S., Tyagi J., Nambiar D., Kakoti M. Community health workers for pandemic response: A rapid evidence synthesis. BMJ Glob. Health. 2020;5 doi: 10.1136/bmjgh-2020-002769.
    1. Egbujie B.A., Delobelle P.A., Levitt N., Puoane T., Sanders D., van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS ONE. 2018;13:e0198424. doi: 10.1371/journal.pone.0198424.
    1. Katigbak C., Van Devanter N., Islam N., Trinh-Shevrin C. Partners in health: A conceptual framework for the role of community health workers in facilitating patients’ adoption of healthy behaviors. Am. J. Public Health. 2015;105:872–880. doi: 10.2105/AJPH.2014.302411.
    1. Hill-Briggs F., Batts-Turner M., Gary T.L., Brancati F.L., Hill M., Levine D.M., Bone L. Training community health workers as diabetes educators for urban African Americans: Value added using participatory methods. Prog. Community Health Partnersh. 2007;1:185–194. doi: 10.1353/cpr.2007.0008.
    1. Swider S.M., Martin M., Lynas C., Rothschild S. Project MATCH: Training for a promotora intervention. Diabetes Educ. 2010;36:98–108. doi: 10.1177/0145721709352381.
    1. Vaughan E.M., Naik A.D., Lewis C.M., Foreyt J.P., Samson S.L., Hyman D.J. Telemedicine Training and Support for Community Health Workers: Improving Knowledge of Diabetes. Telemed J. E Health. 2020;26:244–250. doi: 10.1089/tmj.2018.0313.
    1. Perez-Escamilla R., Damio G., Chhabra J., Fernandez M.L., Segura-Perez S., Vega-Lopez S., Kollannor-Samuel G., Calle M., Shebl F.M., D’Agostino D. Impact of a community health workers-led structured program on blood glucose control among latinos with type 2 diabetes: The DIALBEST trial. Diabetes Care. 2015;38:197–205. doi: 10.2337/dc14-0327.
    1. Silverman J., Krieger J., Sayre G., Nelson K. The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study. J. Community Health. 2018;43:842–847. doi: 10.1007/s10900-018-0491-3.
    1. Vogenberg F.R., Isaacson Barash C., Pursel M. Personalized medicine: Part 1: Evolution and development into theranostics. Pharm. Ther. 2010;35:560–576.
    1. Power R., Nolan J.M., Prado-Cabrero A., Coen R., Roche W., Power T., Howard A.N., Mulcahy R. Targeted Nutritional Intervention for Patients with Mild Cognitive Impairment: The Cognitive impAiRmEnt Study (CARES) Trial 1. J. Pers. Med. 2020;10:43. doi: 10.3390/jpm10020043.
    1. Colleran K., Harding E., Kipp B.J., Zurawski A., MacMillan B., Jelinkova L., Kalishman S., Dion D., Som D., Arora S. Building capacity to reduce disparities in diabetes: Training community health workers using an integrated distance learning model. Diabetes Educ. 2012;38:386–396. doi: 10.1177/0145721712441523.
    1. Vaughan E.M., Hyman D.J., Naik A.D., Samson S.L., Razjouyan J., Foreyt J.P. A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) program for diabetes improves HbA1c: A randomized clinical trial. J. Gen. Int. Med. 2020 doi: 10.1007/s11606-020-06017-4.
    1. Office of the Assistant Secretary for Planning and Evaluation Poverty Guidelines. [(accessed on 17 August 2020)]; Available online: .
    1. Texas Department of State Health Services CHW Certification Requirements. [(accessed on 4 September 2020)]; Available online: .
    1. Zoom Zoom for Healthcare. [(accessed on 4 September 2020)]; Available online: .
    1. Ohmd The Modern Healthcare Communication Platform. [(accessed on 4 September 2020)]; Available online: .
    1. American Diabetes Association Standards of medical care in diabetes 2020. Diabetes Care. 2020;42:S1–S193.
    1. Hoover L.E. Cholesterol Management: ACC/AHA Updates Guideline. Am. Fam. Physician. 2019;99:589–591.
    1. US Preventive Services Task Force Final Recommendations (Screening) [(accessed on 13 July 2020)]; Available online: .
    1. Lorig K., Holman H., Sobel D., Laurent D., Gonzalez V., Minor M. Living a Healthy Life with Chronic Conditions. 4th ed. Bull Publishing Company; Boulder, CO, USA: 2012.
    1. James P.A., Oparil S., Carter B.L., Cushman W.C., Dennison-Himmelfarb C., Handler J., Lackland D.T., LeFevre M.L., MacKenzie T.D., Ogedegbe O., et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8) JAMA. 2014;311:507–520. doi: 10.1001/jama.2013.284427.
    1. Scott K., Beckham S.W., Gross M., Pariyo G., Rao K.D., Cometto G., Perry H.B. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum. Resour. Health. 2018;16:39. doi: 10.1186/s12960-018-0304-x.
    1. De Witt Jansen B., Brazil K., Passmore P., Buchanan H., Maxwell D., McIlfatrick S.J., Morgan S.M., Watson M., Parsons C. Evaluation of the impact of telementoring using ECHO(c) technology on healthcare professionals’ knowledge and self-efficacy in assessing and managing pain for people with advanced dementia nearing the end of life. BMC Health Serv. Res. 2018;18:228. doi: 10.1186/s12913-018-3032-y.
    1. Edirippulige S., Armfield N.R. Education and training to support the use of clinical telehealth: A review of the literature. J. Telemed Telecare. 2017;23:273–282. doi: 10.1177/1357633X16632968.
    1. Lam W.Y., Fresco P. Medication Adherence Measures: An Overview. Biomed. Res. Int. 2015;2015:217047. doi: 10.1155/2015/217047.
    1. United States Census Bureau Census 2020. [(accessed on 5 September 2020)]; Available online: .

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe