Project A-L-L: Reducing disparities among Latinos and improving overall health through a diabetes management program

Background: Diabetes affects over 18 million people in the United States and is growing. The burden of diabetes and its associated co-morbidities is much greater for low-income, ethnic, uninsured populations. Adult Latinos in California age 50 and older suffer from diabetes at more than twice the rate of their White peers. It is projected that Latino children have about a 50% chance of developing Type 2 diabetes in their lifetime. A-L-L -- Aspirin, Lisinopril (ACE Inhibitor), Lovastatin (Statin) -- is a cardiovascular risk reduction model that reduces the incidence rates of strokes and heart attacks in diabetic patients by over 50% and is cost effective.

Objective: Improve health outcomes of underserved, patients with diabetes, age 50 or older, at risk for cardiovascular disease through the implementation of the evidence-based medicine intervention A-L-L and develop delivery system infrastructure to improve the delivery and adherence of medications.

Methods: Through a partnership between an integrated health care delivery system and a community clinic network, Project A-L-L was implemented at three community health centers serving a primarily Latino, uninsured, immigrant, and monolingual Spanish-speaking population. The health care delivery system provided support to the community clinics to improve capacity and infrastructure to increase the number of diabetic patients on A-L-L. Support included improving existing informatics such as disease registries, provider and staff clinical training to improve treatment adherence, patient outreach and in-reach, behavioral health, and improved medication and laboratory access.

Results: To date, more than 900 diabetic patients have been placed on the A-L-L regimen and a greater than 90% adherence rate was achieved. Project A-L-L is not just about diabetes control. While it has improved compliance among diabetic patients, improvements in LDL levels, blood pressure, and self-management goals have been experienced. Clinics have improved pharmacy tracking systems to track over 3,000 filled A-L-L prescriptions. The average cost of medications is approximately $150 per patient per year.

Discussion: The essential components for Project A-L-L's success include bilingual and bicultural outreach, coordinated service delivery (e.g. laboratory and pharmacy), a capable disease/patient registry, and a culturally appropriate healthcare experience.