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1.
Am J Public Health ; 107(10): 1668-1674, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28817321

RESUMO

OBJECTIVES: To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). METHODS: We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. RESULTS: Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = -0.24, -0.06), body mass index decreased 0.29 kilograms per meter squared (CI = -0.39, -0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = -13.5, -10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = -0.7, -0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = -0.14, -0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = -39.0, -6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = -6.6, -0.6) in health center 1 was the only improvement tied to CHW contact. CONCLUSIONS: Although patients' chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs' evolution may elucidate CHW contributions moving forward.


Assuntos
Doença Crônica/terapia , Agentes Comunitários de Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Índice de Massa Corporal , Feminino , Hemoglobinas Glicadas , Comportamentos Relacionados com a Saúde , Humanos , Lipídeos/sangue , Masculino , Saúde Mental , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Navegação de Pacientes , Autocuidado
2.
J Ambul Care Manage ; 40(4): 305-315, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28350634

RESUMO

The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.


Assuntos
Agentes Comunitários de Saúde , Prestação Integrada de Cuidados de Saúde , Documentação , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Papel Profissional , Arizona , Serviços de Saúde Comunitária , Pesquisa Participativa Baseada na Comunidade , Prática Clínica Baseada em Evidências , Feminino , Promoção da Saúde , Hispânico ou Latino , Humanos , Masculino , Patient Protection and Affordable Care Act , Pesquisa Qualitativa
3.
Patient ; 9(4): 293-301, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26689700

RESUMO

BACKGROUND: Consideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services. OBJECTIVES: This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework. RESEARCH DESIGN: Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis. SUBJECTS: Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE. MEASURES: The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data. RESULTS: The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients. CONCLUSIONS: Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.


Assuntos
Comportamento de Escolha , Hispânico ou Latino/psicologia , Serviços de Saúde Mental/organização & administração , Preferência do Paciente , Pobreza , Projetos de Pesquisa , Adulto , Idoso , Pesquisa Participativa Baseada na Comunidade , Competência Cultural , Interpretação Estatística de Dados , Feminino , Grupos Focais , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Encaminhamento e Consulta/organização & administração
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