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Utilization of diabetes management health care services and its association with glycemic control among patients participating in a peer educator-based program in Cambodia.
Rao, Mayuree; van Pelt, Maurits; LoGerfo, James; Steinman, Lesley E; Heang, Hen; Fitzpatrick, Annette L.
Afiliação
  • Rao M; General Medicine Services, VA Puget Sound Health Care System, Seattle, Washington, United States of America.
  • van Pelt M; Department of Medicine, University of Washington, Seattle, Washington, United States of America.
  • LoGerfo J; MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia.
  • Steinman LE; Department of Medicine, University of Washington, Seattle, Washington, United States of America.
  • Heang H; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
  • Fitzpatrick AL; Department of Health Services, University of Washington, Seattle, Washington, United States of America.
PLoS One ; 15(6): e0235037, 2020.
Article em En | MEDLINE | ID: mdl-32584854
BACKGROUND: Substantial evidence supports the effectiveness of peer educator programs for diabetes management in low- and middle-income countries. However, little is known about peer educators' impact relative to other treatment components such as medication and physician consultation. In Cambodia, the non-governmental organization MoPoTsyo organizes four services for people with diabetes: self-management training through peer educator visits, lab tests, physician consultations, and low-cost medicines. Our aims were to 1) quantify MoPoTsyo participant utilization of each program service and 2) define the relationship between each program service and glycemic control. METHODS: We conducted a retrospective cohort study among 4,210 MoPoTsyo participants, using data collected by MoPoTsyo from 2006-2016. Independent variables assessed were medication adherence, number of peer educator visits, number of physician consultations, and number of lab tests. A multiple logistic regression model was used to evaluate the association between these disease management services and glycemic control-fasting plasma glucose ≤130 mg/dl or post-prandial glucose ≤180 mg/dl-based on most recent glucose level. The model was adjusted for baseline demographic and disease characteristics. FINDINGS: Participants with 12 or more peer educator visits per year had a 35% higher odds of glycemic control relative to participants with 4 or fewer visits (odds ratio 1.35, 95% CI: 1.08-1.69; p = 0.009), after adjustment for utilization of other treatment components (medication adherence, number of physician visits, number of lab tests), follow-up time, and demographic and disease characteristics. Better adherence to medications and a greater number of lab tests per year were also associated with a higher odds of glycemic control after adjustment. Number of physician consultations was not associated with glycemic control after adjustment. CONCLUSIONS: This study demonstrates a positive association between peer educator utilization and glycemic control incremental to other elements of diabetes management. These results suggest that peer educators may be a valuable addition to comprehensive diabetes management programs in low- and middle-income countries even when other health care services are accessible. The associations identified in this research warrant further prospective studies to explore the causal impact of peer educators on glycemic control relative to other disease management components.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Glicemia / Educação de Pacientes como Assunto / Diabetes Mellitus / Adesão à Medicação Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Glicemia / Educação de Pacientes como Assunto / Diabetes Mellitus / Adesão à Medicação Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Ano de publicação: 2020 Tipo de documento: Article