PRP124: Mentored Implementation of a telehealth, CHW diabetes program to improve HbA1c: A Randomized Clinical Trial (Pilot Study)
Elizabeth Vaughan, DO, MPH
Context: We have previously found that a Telehealth-support, Integrated Community Health Worker (CHW), Medication-access, group visit Education (TIME) diabetes program improves glycemic control. However, it was unclear if outcomes were the reflection of a research-team run investigation or if local clinics could produce similar results. Setting: Community Clinic. Population: low-income Latino(as) with type 2 diabetes (N=37). Objective: To clarify the community clinic’s ability to implement TIME. Study Design: Pilot. Participants were randomized to the intervention (TIME) or usual care (wait-list control). Outcome Measures: Change of HbA1c (primary), CHW knowledge pre/post training, and provider prescribing practices of accessible medications. Intervention: PHASE 1 (training, 3-months) A study physician taught diabetes medication management to clinic providers. Local CHWs (n=6) were recruited and received a 1-hour training session on diabetes care. PHASE 2 (observation, 6-months) The research team (one physician, six CHW-Instructors (CHWIs)) led the intervention’s once/month TIME program while the clinic team (two providers, six CHWs) observed (feasibility). PHASE 3 (mentored implementation, 6-months) The clinic team led the group visits for wait-list control participants and the research team provided in-person support. CHWs were partnered with CHWI mentors who contacted them by mHealth (mobile health) weekly for support, and the study physician met with clinic providers by telehealth monthly for mentorship. CHWs also received weekly, one-hour telehealth training. CHWs completed a pre/posttest related to their diabetes training at baseline and month-6 during PHASE 3. Anticipated Results. A local clinic will successfully implement TIME as measured by improved HbA1c levels (X%) (PHASE 3). We also anticipate to find significant changes in provider prescribing practices to more accessible medications pre/post education (p=X) (PHASE 1), program feasibility in a clinic naïve to TIME as measured by superior HbA1c levels of the intervention compared to the wait-list control arm (PHASE 2), and that CHWs will improve their knowledge of diabetes as measured by 6-month pre/posttests (X vs Y%, p=X (PHASE 3). Expected Outcomes. We anticipate to report a novel strategy of a mentored-approached that incorporates telehealth support to improve diabetes care.