RESUMO
AIMS: To give an updated perspective of interventions from additional data collected since our first review, conducted in 2008. BACKGROUND: This updated Cochrane Review incorporates new information from recent randomized controlled trials on culturally appropriate diabetes health education interventions. METHODS: An electronic literature search of six databases was repeated, with databases of ongoing trials checked and three journals hand-searched. Meta-analysis was carried out for sufficiently homogeneous outcomes, and common themes among trials were highlighted. RESULTS: A total of 22 new trials were added to the original 11. Meta-analysis of 28 trials containing suitable data showed significant improvements in glycaemic control (HbA1c ) and diabetes knowledge over a period of 24 months, after the delivery of culturally appropriate education to participants, compared with those receiving 'conventional' care. There were no consistent benefits over the control group in other selected outcome measures, and lack of data continued to make analysis of several outcome measures difficult. CONCLUSIONS: Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.
Assuntos
Assistência à Saúde Culturalmente Competente , Diabetes Mellitus Tipo 2/terapia , Medicina Baseada em Evidências , Disparidades nos Níveis de Saúde , Saúde das Minorias , Educação de Pacientes como Assunto , Terapia Combinada/tendências , Assistência à Saúde Culturalmente Competente/tendências , Países Desenvolvidos , Complicações do Diabetes/etnologia , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Política de Saúde/tendências , Transição Epidemiológica , Humanos , Hipoglicemia/prevenção & controle , Saúde das Minorias/educação , Saúde das Minorias/tendências , Cooperação do Paciente/etnologia , Educação de Pacientes como Assunto/tendências , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos TestesRESUMO
This article critiques the current health care system and presents a new conceptual model that offers the potential for an integrated health care system in the future. Health care currently consists of parallel care systems based on the competing conceptual frameworks of the medical model and the psychosocial model. It is argued that psychosocial factors must be included in an integrated system. Research literature is reviewed that documents the need for, the therapeutic effectiveness of, and the medical cost-offset benefits of mental and behavioral health interventions. The Health and Human Risk Management Model is described and illustrated with a case example as well as research outcomes from its implementation at United HealthCare Corporation.