Strengthening Primary Care
Peer support programs can strengthen primary care practice and community health, reaching vulnerable populations and reducing health disparities. Through the work of promotores, it can even address the social determinants of health.
In this issue of the PfP newsletter, we spotlight a peer health coaching program in a primary care setting that has helped low-income, minority patients manage their diabetes. You will also find program resources and research briefs about the impact of peer support on disadvantaged populations.
Peer Support, Primary Care and Health Disparities
PfP grantees at the Center for Excellence in Primary Care have demonstrated the effectiveness of a diabetes peer health coaching model to improve glycemic control for low-income patients in a primary care setting. Within this population, peer coaches had the highest impact on patients with poor self-management skills and low medication adherence. The evidence from this randomized controlled trial suggests that peer support is an effective strategy to extend and enhance primary care for diabetes, especially for people that need it most. [Read More]
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Peer Health Coach Training Curriculum
This curriculum was developed by Bodenheimer and colleagues at the Center for Excellence in Primary Care to train peer health coaches to support diabetes self-management. The 36-hour training is intended to be delivered over 8 weeks. The instructional modules are highly standardized, while the training approaches are creative and interactive, using small group didactics, role-playing, and observed practice coaching sessions. [Read More]
Texas Community Health Worker Study
Texas was the first state that passed legislation to establish and operate a training and certification program for promotores, instructors, and sponsoring institutions. Since the program was implemented in 2001, about 2,150 promotores have been certified. This 2-page factsheet provides a brief overview of the program. For a comprehensive report, see the Texas Community Health Worker Study, which was submitted to the state legislature in December 2012.
Community Health Worker Assessment and Improvement Matrix
USAID created the CHW AIM Toolkit to help ministries, donors, and NGOs assess and strengthen their CHW programs. The toolkit is framed around two key resources: a program functionality matrix with 15 key components used by participants to assess the current status of their programs, and a service intervention matrix to determine how CHW service delivery aligns with program and national guidelines. [Read more]
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A Diabetes Peer Support Intervention that Improved Glycemic Control: Mediators and Moderators of Intervention Effectiveness
Piette and colleagues conducted a secondary analysis on a successful diabetes peer support intervention to test whether improvements in HbA1c were 1) mediated by insulin uptake or perceived diabetes social support, and 2) moderated by health literacy, diabetes social support, or diabetes distress (n=212). The study found that patients receiving increased peer support had improved glycemic control largely due to their greater likelihood of initiating insulin. Greater intervention engagement was associated with stronger effects. The intervention had its greatest benefits among patients with low support or poorer health literacy. [Full Abstract]
Advanced Primary Care in San Antonio: Linking Practice and Community Strategies to Improve Health
This paper describes an emerging community of solution for 6000 San Antonio residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses. Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores whose mission encompasses change at both the individual and community levels. Centered on patients' functional goals, promotores mobilize family and community resources and consider what community-level action will address the social determinants of health. [Full Abstract]
Cost-Effectiveness of Nurse Practitioner/Community Health Worker Care to Reduce Cardiovascular Health Disparities
Allen and colleagues evaluated the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure, and HbA1c levels in patients in urban community health centers (n=525). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, and $149 per 1% drop in HbA1c, suggesting that management by a NP/CHW team is a cost-effective approach for CVD patients. [Full Abstract]
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NIH Dissemination and Implementation Research in Health
DEADLINE: June 5, 2013
FUNDS: $500,000 total for up to 5 years
This opportunity encourages investigators to submit research grant applications that will identify, develop, evaluate and refine effective and efficient methods, systems, infrastructures, and strategies to disseminate and implement research-tested health behavior change interventions, evidence-based prevention, early detection, diagnostic, treatment and management, and quality of life improvement services, and data monitoring and surveillance reporting tools into public health and clinical practice settings that focus on patient outcomes. [More Info]
HHS/SAMHSA/CMHS Implementation Cooperative Agreements for Expansion of Comprehensive Community Mental Health Services for Children and Their Families Program
DEADLINE: June 19, 2013
FUNDS: $1,000,000 per year for up to 4 years
This cooperative agreement is intended to support the provision of mental health and related recovery support services to children with serious emotional disturbances. This program supports broad-scale operation, expansion and integration of systems of care through the creation of sustainable infrastructure. [More Info]
CMS Health Care Innovation Awards
DEADLINE: LOI - June 26, 2013
DEADLINE: Application - August 15, 2013
FUNDS: $1 million to $30 million per award for 3 years
The second round of Health Care Innovation Awards will fund applicants who propose new payment and service delivery models that have the greatest likelihood of driving health care system transformation and delivering better outcomes for Medicare, Medicaid, and CHIP beneficiaries in four categories. One category is “Models that improve the health of populations.” These models may include community based organizations or coalitions and may leverage community health improvement efforts. Priority areas are: models that lead to better prevention and control of CVD, hypertension, diabetes, asthma; models that promote behaviors that reduce risk for chronic disease; models that promote medication adherence and self-management skills; and broader models that link clinical care with community-based interventions. [More Info]
American Diabetes Association Innovation Award
DEADLINE: July 16, 2013
FUNDS: $50,000 per year for up to 2 years
Innovation Awards are intended to provide grant support to investigators who have creative and innovative proposals that hold significant promise for advancements in the prevention, cure, or treatment of diabetes.
These awards are intended to support projects that 1) are high-risk, but have potential for high-impact results, 2) extend existing knowledge into a new area or application, and/or 3) utilize novel cross-disciplinary approaches. It is expected that an application for this award will generally lack significant preliminary data, however data supporting the feasibility of the proposed approach is encouraged. [More Info]
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