Monday, April 29, 2019

Community Health Workers Can Deliver Patient-Centered, Evidence-Based, Value-Based Services

Today, healthcare is striving to practice medicine that is patient-centered, evidence-based, and value-based. What this means is that the patient is to be viewed as the most important person in the room, the providers are to use evidence-based medicine, and the patient gets a lot for his or her money. And it has been shown that community health workers (CHWs) can play an important role in delivering services associated with patient-centered, evidence-based, value-based medicine. A set of these services is related to the Centers for Disease Control and Prevention (CDC) sponsored Diabetes Prevention Program (DPP).

Patient-centered means providing medical care “that is focused on the patient or consumer of health care rather than on health care providers, financiers, insurers, or institutions.” “Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.” And value-based medicine is where “providers, including hospitals and physicians, are paid based on patient health outcomes.” One way of looking at value-based medicine is patient-outcomes divided by cost (patient-outcomes/cost).

According to the CDC, “a community health worker (CHW) is a frontline public health worker who is a trusted member or has a particularly good understanding of the community served.” CHWs may work as coaches in some community organizations. These organizations include YMCA’s, churches and other community groups that offer community services. One of the important services is the Diabetes Prevention Program or DPP.

The DPP is based on a study done between 1996 and 2001. In the study, it was concluded that type 2 diabetes can be avoided or delayed in an individual who follows a healthy diet, engages in purposeful physical activity, and changes his or her lifestyle to include healthy activities. After the completion of the study, it was determined that lifestyle CHWs working as coaches could successfully motivate individuals to engage in DPP related activities.

Furthermore, healthcare providers are encouraged to refer patients to DPP organizations that have satisfied DPP standards established by the CDC.

Wednesday, April 24, 2019

Prediabetes Can Be Effectively Treated in a Primary Care Setting

According to the  Centers for Disease Control and Prevention (CDC), prediabetes is a chronic disease. The disease affects 88% of the adults in the U.S. And having prediabetes raises the risk for a number of diseases, including diabetes, heart disease, stroke, and other conditions. The CDC established the Diabetes Prevention Program (DPP) in 2012 to address prediabetes. The DPP is based on a study, funded by the National Institutes of Diabetes and Digestive and Kidney Disease (NIDDK). The study was done and reported on between 1996 and 2002. The services delivered in the DPP are being delivered in community organizations, including YMCAs and churches. And the DPP services can be delivered in a primary care setting.

A study was done in New Zealand using a nurse-led diabetes prevention program in a primary setting. One hundred fifty-seven patients with prediabetes were enrolled in the six month study. Two groups were formed for the study, where 85 of the participants comprised the intervention group and 72 participants were in the control group. HbA1c, BMI and waist circumference were analyzed, and it was found that these parameters decreased in the intervention group while they increased in the control group.

While the differences in outcomes between the intervention group and the control group were not statistically significant, the study showed that the DPP program can work well in a primary care setting. The program was acceptable to the patients and the nurses.

Another study confirmed the effectiveness of wellness coaching programs addressing prediabetes in a primary care setting. A survey was used to evaluate the experiences of participants in a 12 week prediabetes program in a primary care setting. Sixty-three percent of the participants completed the survey. And the participants were very satisfied with the program.

This means that primary care practices might want to focus on integrating prediabetes treatment procedures into the practices. The integration could reduce the number of patients who eventually experience type 2 diabetes. 

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