Vicki J. Karlan, MPH¹, Kenneth S. Babamoto, PharmD, MPH², Carlos N. Casas-Zaragosa, MD³, Lourdes Rangel³, Miguel Treviño³, Lucy Garcia, RN, BSN³, Angela J. Camilleri, MPH, MA², Eileen Crowley², Julia D Portale, MPH, MBA², and Donald E. Morisky, ScD⁴. (1) Outcomes and Analytics, Pfizer Health Solutions, 2400 Broadway, Suite 500, Santa Monica, CA 90404, 310-586-2510, vicki.karlan@pfizer.com, (2) Community Health, Pfizer Health Solutions, 2400 Broadway, Suite 500, Santa Monica, CA 90404, (3) Gateway Community Health Centers, Inc., 2309 Saunders, Laredo, TX 78044, (4) Community Health Sciences, UCLA School of PUblic Health, Box 951772, Los Angeles, CA 90095-1772

The South Texas – Mexico Border region presents unique challenges to the US healthcare system. The predominate Hispanic population (~88%) living in this area is growing rapidly, attributed to high birthrates, immigration patterns, and lower age-specific mortality rates. Environmental issues such as air pollution, lack of clean drinking water and centralized wastewater treatment services especially in colonias (unincorporated, semi-rural communities) contribute to high rates of infectious diseases. Socioeconomic issues including unemployment, significant poverty, low education levels, substance abuse, limited access to care, and no health insurance further contribute to the region’s health problems. Diabetes, cardiovascular disease, asthma, and obesity are highly prevalent with depression, anxiety and stress also thought to be common but significantly underreported. Adding to this complex geographic, demographic and socioeconomic triad is an ongoing shortage of trained healthcare professionals in primary care and mental health services, all of which contribute to the major health disparities that exist in this region.

To address these problems, Gateway Community Health Center in Laredo, Texas and Pfizer Health Solutions have implemented Amigos en Salud, a two-year randomized, controlled clinical trial using trained community health workers (CHWs), or promotores, working directly in concert with clinic providers, to provide diabetes self-management education and depression management. Using a 3-arm design (intervention, wait-list control and no-contact control), the study will enroll a total of 540 participants: 360 in the CHW-directed intervention and 180 in control groups.

At baseline, patients enrolled to date can be described as follows: mean age of 59 years; predominantly female gender (70%); 80% speak only Spanish at home; 57% reported total annual household income less than $10,000; and 65% reported < 6th grade education. Preliminary follow-up results have revealed participant improvement in regular physical activity (> 3 days/wk) from 37% to 71%; healthier eating (> 2 servings of fruit) from 52% to 60%; improved diabetes self-management skills including daily blood glucose monitoring (42% to 60%); improved daily feet assessment (84% to 90%); and more frequent diabetes preventive care including regular dental visits (19% to 43%) and dilated eye examinations (67% to 93%). Improvements in mental health status were reflected by a 31% reduction in depression severity and a decrease in patients with anxiety symptoms (58% to 28%).

This is the first large scale randomized controlled trial using trained CHWs to provide both diabetes and co-morbid depression education and management. Study design, intervention and final results will be presented.

Learning Objectives:

• 1. List 3 factors that contribute to health disparities in the South Texas-Mexico border region.
• 2. Describe 3 benefits of a 3-arm study design.
• 3. Identify 5 health indicators that are impacted by a CHW intervention.

Keywords: Health Disparities, Chronic Diseases

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment