Health Promoters and Pharmacists in Diabetes Team Management

Abstract

Many African-Americans and Latinos with diabetes do not achieve the recommended goals for normal blood sugar, blood pressure, or cholesterol level, placing them at high risk for complications. This study evaluates the impact of a novel intervention designed to improve lifestyle behaviors and medication adherence, and intensify therapy to reach goals.

The first component of the intervention includes a clinic-based pharmacist disease management program, including detailed patient assessments, physician-approved treatment plans, patient education and support services to enhance medication adherence. In addition, this program includes intensification of medication therapy to improve blood sugar, blood pressure, and cholesterol levels to reach recommended goals.

The second component of the intervention includes health promoters (HPs), or community-based lay health workers. Health promoters are commonly found in minority communities and provide assistance for neighbors overcoming language, cultural, and other barriers to conventional health care services. They may provide autonomy support and solve problems related to medication adherence barriers. Furthermore, health promoters may complement pharmacist activities by improving access to medications, assisting in continuity of care with providers, monitoring response to therapy, and reinforcing educational messages.

The study will determine whether the addition of health promoters to clinic-based pharmacist service delivery improves care. The study will involve the recruitment of 300 African American and Latino adults with uncontrolled diabetes through the University of Illinois Medical Center in Chicago and randomization to one of two groups: (1) pharmacist management (Pharm) for 12 months; or (2) pharmacist management with HP support (Pharm+HP) for 12 months. Cross-over will occur at 12 months such that the Pharm group will be intensified by the addition of HP support and HP support will be phased out from the Pharm+HP group to assess maintenance.

The specific aims include:

  1. To evaluate the effectiveness of Pharm+HP compared with Pharm alone on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels
  2. To evaluate the maintenance of improved diabetes behaviors as well as clinical outcomes by phasing out HP support from the Pharm+HP group after year 1
  3. To evaluate the intensification offered by adding an HP after one year of Pharm alone
  4. To evaluate the cost and cost-effectiveness of Pharm+HP and Pharm alone.

Affiliated Center/Program

Principal investigator
Funding Agency

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (Grant No. 1 R01 DK091347)

Start date
05/01/2011
End date
02/29/2016
Total award
$3,001,958
About this grant

Preliminary work for this study was done with the support of IHRP pilot funding.

Related publications


See publications supported by this grant on this PubMed list

Syed ST, Sharp LK, Kim Y, Jentleson A, Lora CM, Touchette DR, Berbaum ML, Suda KJ, Gerber BS. Relationship between Medication Adherence and Distance to Dispensing Pharmacies and Prescribers Among an Urban Medicaid Population with Diabetes Mellitus. Pharmacotherapy. 2016 Apr 18.[Epub ahead of print]. [See abstract.]

Rojas E, Gerber BS, Tilton J, Rapacki L, Sharp LK. Pharmacists' perspectives on collaborating with community health workers in diabetes care. J Am Pharm Assoc (2003). 2015 Jul-Aug;55(4):429-33. [See abstract.]

Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013 Oct;38(5):976-93. [See abstract.]

Lora CM, Sokolovsky AW, Touchette DR, Jin J, Hu X, Gao W, Gerber BS. ACE inhibitor and ARB medication use among Medicaid enrollees with diabetes. Ethn Dis. 2013 Spring;23(2):189-95. [See abstract.]

Gerber BS, Rapacki L, Castillo A, Tilton J, Touchette DR, Mihailescu D, Berbaum ML, Sharp LK. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with diabetes. BMC Public Health. 2012 Oct 23;12:891. [See abstract.]