Researchers at the University of Illinois at Chicago's Institute for Health Research and Policy and College of Medicine have received a $3 million federal grant to improve diabetes management in minority patients.
The grant will fund a five-year study to evaluate a new intervention designed to improve lifestyle behaviors and medication compliance and to intensify therapy in minority patients with uncontrolled type 2 diabetes.
African-Americans and Latinos with diabetes often do not reach desired blood sugar, blood pressure or cholesterol levels, placing them at high risk for complications or death.
"We know there's a breakdown in the current health care system," said Lisa Sharp, assistant professor of medicine and co-principal investigator of the study. "Even when patients have access to quality health care, there are many other economic, social and cultural factors that contribute to them not meeting their therapeutic goals."
The researchers will enroll 300 African-American and Latino adults with uncontrolled diabetes from the University of Illinois Medical Center. Patients will be randomly assigned to one of two groups.
In the first group, a clinic-based pharmacist will educate patients about diabetes, reconcile their medications, and address any compliance barriers. In the second group, a community-based lay health worker (or health promoter) will team with the clinic-based pharmacist to assist with cultural and language barriers, reinforce educational messages, provide support, help solve problems related to compliance, and assist in continuity of care.
"The pharmacist, working with a lay health worker, may help create a bridge, because there's this huge chasm between the patient and the health care provider," said Dr. Ben Gerber, associate professor of medicine. "A lot of times, people will leave their doctor's office, and they have a lot of questions and don't understand things."
For example, a physician may prescribe a new insulin pen, but the patient may not know how to use it properly. The pharmacist may demonstrate it, but some patients may need additional practice that can be reinforced by a health promoter. Language barriers may also hinder understanding.
After one year, the participants who didn’t receive health promoters will begin to receive health promoter support, while health promoter support for the other group will be phased out to assess maintenance and clinical outcomes.
"There needs to be some adaptability to serve the patient's needs," said Gerber, co-principal investigator of the study.
Patients often bounce from the emergency room to the clinic to home and back again. Often there is a "hands-off" approach to figuring out what may be causing missed appointments or medication lapses, Gerber said.
Instead, we should "try to figure out what the problems might be because if we address them it might actually help their ability to come to the clinic, to take their medicine, and maybe prevent them from being hospitalized, especially for diabetes-related problems," Gerber said.
The grant, from the National Institute of Diabetes and Digestive and Kidney Diseases, builds on a previous pilot study conducted by Gerber and Sharp funded by the UIC Institute for Health Research and Policy.
Co-investigators, all of UIC, are Dan Touchette, assistant professor of pharmacy practice and pharmacy administration, Dr. Amparo Castillo, training and research coordinator in the Jane Addams College of Social Work, Dan Mihailescu, assistant professor of medicine, and Mike Berbaum, director of the Institute for Health Research and Policy Methodology Research Core.
Gerber and Sharp are members of the UIC Cancer Center Cancer Control and Population Science Research Program.