Patient navigators can benefit diabetes outcomes

A new study seeks to determine whether significant improvement in glycemic control—the management of blood sugar levels in a person with diabetes mellitus—can be achieved when regular mentoring or coaching is part of the process.  

University of Alabama at Birmingham (UAB) School of Nursing assistant professor Michele Talley, PhD, and researchers are testing their hypothesis with a $30,000 grant from the UAB Center for the Study of Community Health, as part of their work at the Providing Access to Healthcare (PATH) Clinic, which the school supports in partnership with UAB Hospital and the UAB Health System.  

Talley

"A lot of times, people assume that patients don’t adhere to treatment simply because they don’t want to or they lack the discipline to do it," said Talley, adult acute care nurse practitioner-BC, assistant professor/ director for MSN program, adult/acute health, chronic care and foundations department, UAB. "I may have been guilty of that myself 10 years ago, but what I have come to realize is that often a lack of knowledge about diabetes is the real issue."

The study, 'Impact of Community Health Advisors for Uninsured Adults with Diabetes at PATH," will be conducted in 2 phases and is currently in the recruitment stage of phase 1 for a focus group discussion regarding diabetes self-care topics. The participants will come for a focus group meeting (10 men for one group and 10 women for the second focus group).

"The interviewer will be using a semi-structured interview guide to obtain feedback on the topics of interest to the participants regarding diabetes self-care," Talley said. "After obtaining this feedback, we will begin phase 2 of the study."

During phase 2, a total of 60 participants will be recruited. Thirty participants will participate in the intervention group and another 30 participants will comprise the control group. The intervention group will be divided into groups of 6 and a community health advisor (CHA) will be assigned to them.

The CHAs, provided through a partnership with the Deep South Cancer Network, are laypeople from the community whom Talley will train in behaviors of interest identified by the first focus groups. 

The participants in the intervention group will have regular access to a CHA throughout the 12-week study, including face-to-face meetings in weeks one and 12 and weekly contact by phone in weeks two through 11. During these sessions, the CHAs will educate the participants on the previously identified self-care behaviors of interest. 

The outcome variables will include: improved glycemic control (measured by A1c), compliance (measured by adherence to self-care behaviors via self-report on the cards), and decreased hospital and/or emergency department utilization (measured by self-reported emergency department visits and length of stay in days).

Talley anticipates the study will show the use of CHAs improves compliance with self-care routines, leading to improved levels of hemoglobin A1c—the test that provides an average of a person’s blood sugar level over a 90- to 120-day period—as well as fewer trips to the emergency room and fewer readmissions after hospital stays. 

"This study may impact the way formulary managers and managed care organizations work with patients," Talley said. "If a coach or CHA is assigned to several patients, these patients may have better outcomes. These outcomes could essentially save managed care organizations money as it has been proven to show at the PATH Clinic."

Care and compliance

People with numerous social and health needs tend to also be high consumers of services provided by emergency departments and hospitals, according to Talley.

"Because the cost of caring for such individuals is high, identifying novel ways to reduce these costs is of importance to those paying for the care," she said. "The purpose of the study is to determine the effectiveness of using CHAs as an intervention in a group of adult patients with diabetes from the PATH clinic."

More specifically, according to Talley, the CHAs will attempt to enhance peer-support and self-care behaviors known to impact glycemic outcomes in an effort to increase compliance with medical recommendations, encourage alternatives to emergency department utilization, and assist with other barriers to care.

"The study is novel in utilizing a community partner whose focus has historically been with cancer patients in order to determine if similar health outcomes can be achieved in this relatively middle-aged, largely African-American urban population," Talley said. "Another novel aspect involves having the participants determine the target behaviors prior to the initiation of the intervention.

"We may indeed find that CHAs are especially important for patients with any chronic disease not just diabetes," Talley added. "This could result in better health outcomes for patients and cost savings for institutions. It then is a win-win for both patients and healthcare systems."