Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110149

Kenneth S. Babamoto, PharmD, MPH¹, Carol A. Brownson, MSPH², Gowri Shetty, MPH, MS³, Armando R. Hinojosa, MD⁴, Carlos N. Casas, MD⁴, Ed Fisher, PhD², Lucy Garcia, RN, BSN⁵, Lourdes Rangel⁴, Angela J. Camilleri, MPH, MA¹, Vicki J. Karlan, MPH⁶, and Miguel Trevino⁴. (1) Community Health, Pfizer Health Solutions, 2400 Broadway, Suite 500, Santa Monica, CA 90404, 310-586-2508, ken.babamoto@pfizer.com, (2) Robert Wood Johnson Foundation Diabetes Initiative, National Program Office, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 6700, St. Louis, MO 63108-2212, (3) Division of Health Behavior Research, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 6700, St. Louis, MO 63108-2212, (4) Gateway Community Health Center, 2309 Saunders, Laredo, TX 78044, (5) Gateway Community Health Centers, Inc., 2309 Saunders, Laredo, TX 78044, (6) Outcomes and Analytics, Pfizer Health Solutions, 2400 Broadway, Suite 500, Santa Monica, CA 90404

Diabetes with comorbid depression proposes significant challenges to the US healthcare system. Diabetes is 2-3 times more common in Mexican-Americans than in non-Hispanic whites. In the medically underserved region of the South Texas Border, diabetes is reaching epidemic proportions.

The Chronic Care Model (CCM) improves clinical and functional outcomes by shifting the focus of care from acute to chronic management. However, only half of the 700 federally funded primary care community health centers have adopted the CCM. Implementing the essential “self-management support” component yields substantial difficulties due to physicians' time constraints, overburdened healthcare systems, and inadequate technology.

Given these challenges, Gateway Community Health Center (GCHC) in Laredo, Texas successfully implemented the CCM to address the growing diabetes and comorbid depression prevalence. Supported in part by Robert Wood Johnson Foundation's Diabetes Initiative and Pfizer Health Solutions' Amigos en Salud research programs, GCHC trained community health workers (CHWs) to follow protocols and provide culturally relevant interventions. Using literacy- and culturally-appropriate education materials and electronic data collection/reporting tools, CHWs facilitate group classes/support groups, conduct individual assessments, help establish goals based on evidence-based guidelines, problem-solve, and monitor patient status.

To date, 687 patients have been enrolled. Preliminary results show improved clinical values (A1c decreased: 8.7%-7.7%), self-management behaviors (regular exercise increased: 34%-49%), and depression severity (PHQ decreased: 7.0-3.7). Final clinical and behavioral results will demonstrate how the CCM, augmented with CHWs, is a successful strategy to reduce health disparities and healthcare costs. Program results will be used to inform policy decisions regarding chronic care delivery.

Learning Objectives:

• Describe how the Chronic Care Model could be implemented as a way to reduce health disparities among Hispanics with diabetes and comorbid depression.
• List 3 ways that trained lay Community Health Workers assist in achieving self-management support for diabetes care.
• Identify 3 outcome measures that would indicate improved health status for Hispanics with diabetes and comorbid depression.

Keywords: Hispanic, Diabetes

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF Employment.

Recorded presentation