TY - JOUR
T1 - Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness
T2 - Safety net care system clinical trial results
AU - Ell, Kathleen
AU - Aranda, María P.
AU - Wu, Shinyi
AU - Oh, Hyunsung
AU - Lee, Pey Jiuan
AU - Guterman, Jeffrey
N1 - Funding Information:
This study is supported by the Patient-Centered Outcomes Research Institute (PCORI grant number: AD-1304-7364) and activated by Principal Investigator, K. Ell. Trial Registration: NCT02147522, clinicaltrials.gov/ct. The corresponding author at the USC Suzanne Dworak-Peck School of Social Work, University of Southern California is Kathleen Ell (ell@usc.edu). Drs. Maria Aranda and Shinyi Wu, Co-Investigators had significant study roles, Dr. Hyunsung assisted while working on his doctoral dissertation, Pey-Jiuan Lee provided data management and analysis, and Dr. Guterman, the Chief of Research and Innovation Officer in the Ambulatory Care Network of the LAC-DHS, provided consultation.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/10
Y1 - 2017/10
N2 - The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12 months was 30% (AHH 31%, UC 28%, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.
AB - The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12 months was 30% (AHH 31%, UC 28%, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.
KW - Chronic disease management
KW - Community health worker
KW - Depression
KW - Latino
KW - Promotora
KW - Safety net care system
UR - http://www.scopus.com/inward/record.url?scp=85024391567&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85024391567&partnerID=8YFLogxK
U2 - 10.1016/j.cct.2017.07.001
DO - 10.1016/j.cct.2017.07.001
M3 - Article
C2 - 28684357
AN - SCOPUS:85024391567
SN - 1551-7144
VL - 61
SP - 1
EP - 9
JO - Contemporary Clinical Trials
JF - Contemporary Clinical Trials
ER -