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Published in: Current Diabetes Reports 7/2015

01-07-2015 | Psychosocial Aspects (KK Hood and S Jaser, Section Editors)

Linking Community Resources in Diabetes Care: a Role for Technology?

Authors: Elizabeth L. Tung, Monica E. Peek

Published in: Current Diabetes Reports | Issue 7/2015

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Abstract

Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as “assets”). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.
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Literature
1.
go back to reference Knowler WC, Barrett-Connor E, Nathan DM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed Knowler WC, Barrett-Connor E, Nathan DM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed
2.
go back to reference Knowler WC et al. Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2014;2(10):801–9.CrossRefPubMedCentral Knowler WC et al. Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2014;2(10):801–9.CrossRefPubMedCentral
3.
go back to reference Sidaway P. Clinical trials: lifestyle intervention reduces CKD risk associated with type 2 diabetes. Nat Rev Nephrol. 2014;10(11):613. Sidaway P. Clinical trials: lifestyle intervention reduces CKD risk associated with type 2 diabetes. Nat Rev Nephrol. 2014;10(11):613.
4.•
go back to reference Felix HC, Mays GP, Olson M, et al. The Care Span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Aff (Millwood). 2011;30(7):1366–74. This article describes the potential cost-savings when health care systems are able to match existing community resources to patient needs.CrossRef Felix HC, Mays GP, Olson M, et al. The Care Span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Aff (Millwood). 2011;30(7):1366–74. This article describes the potential cost-savings when health care systems are able to match existing community resources to patient needs.CrossRef
5.
go back to reference Horowitz CR, Eckhardt S, Lorig K, et al. Effectively translating diabetes prevention: a successful model in a historically underserved community. Transl Behav Med. 2011;1(3):443–52.CrossRefPubMedCentralPubMed Horowitz CR, Eckhardt S, Lorig K, et al. Effectively translating diabetes prevention: a successful model in a historically underserved community. Transl Behav Med. 2011;1(3):443–52.CrossRefPubMedCentralPubMed
6.•
go back to reference Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chron Dis. 2013;10:E26. This article gives a useful review of CCM interventions in US primary care settings, and describes the deficiency in community resource linkages currently available. Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chron Dis. 2013;10:E26. This article gives a useful review of CCM interventions in US primary care settings, and describes the deficiency in community resource linkages currently available.
7.
go back to reference Pearson ML, Wu S, Keeler EB, et al. Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res. 2005;40(4):978–96.CrossRefPubMedCentralPubMed Pearson ML, Wu S, Keeler EB, et al. Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res. 2005;40(4):978–96.CrossRefPubMedCentralPubMed
8.•
go back to reference Cotter AP, Durant N, Cherrington AL, et al. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complicat. 2014;28(2):243–51. This article describes the My Diabetes Connect program discussed in this paper.CrossRefPubMed Cotter AP, Durant N, Cherrington AL, et al. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complicat. 2014;28(2):243–51. This article describes the My Diabetes Connect program discussed in this paper.CrossRefPubMed
9.
go back to reference Plumb J, Weinstein LC, Scott K, et al. Community-based partnerships for improving chronic disease management. Prim Care. 2012;39(2):433–47.CrossRefPubMed Plumb J, Weinstein LC, Scott K, et al. Community-based partnerships for improving chronic disease management. Prim Care. 2012;39(2):433–47.CrossRefPubMed
10.•
go back to reference Ludwig J, Sanbonmatsu L, McDade TW, et al. Neighborhoods, obesity, and diabetes—a randomized social experiment. N Engl J Med. 2011;365(16):1509–19. This article demonstrates the causal influence of the neighborhood resource environment in diabetes-related outcomes.CrossRefPubMedCentralPubMed Ludwig J, Sanbonmatsu L, McDade TW, et al. Neighborhoods, obesity, and diabetes—a randomized social experiment. N Engl J Med. 2011;365(16):1509–19. This article demonstrates the causal influence of the neighborhood resource environment in diabetes-related outcomes.CrossRefPubMedCentralPubMed
12.
go back to reference Baig AA, Wilkes AE, Chin MH, et al. The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients. Med Care Res Rev. 2010;67(5 Suppl):163S–97.CrossRefPubMedCentralPubMed Baig AA, Wilkes AE, Chin MH, et al. The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients. Med Care Res Rev. 2010;67(5 Suppl):163S–97.CrossRefPubMedCentralPubMed
13.
go back to reference Makelarski JA, Lindau ST, Johnson D, et al. Are your asset data as good as you think? Conducting a comprehensive census of built assets to improve urban population health. J Urban Health. 2013;90(4):586–601.CrossRefPubMedCentralPubMed Makelarski JA, Lindau ST, Johnson D, et al. Are your asset data as good as you think? Conducting a comprehensive census of built assets to improve urban population health. J Urban Health. 2013;90(4):586–601.CrossRefPubMedCentralPubMed
14.
go back to reference Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95–124.CrossRefPubMed Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95–124.CrossRefPubMed
15.
go back to reference Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed
17.•
go back to reference Goddu AP, Roberson TS, Peek ME, et al. Food Rx: a community-university partnership to prescribe healthy eating on the south side of Chicago. J Prev Interv Community. 2015. This article describes the Food Rx intervention discussed in this paper. Goddu AP, Roberson TS, Peek ME, et al. Food Rx: a community-university partnership to prescribe healthy eating on the south side of Chicago. J Prev Interv Community. 2015. This article describes the Food Rx intervention discussed in this paper.
18.
go back to reference Swinburn BA, Walter LG, Russell DG, et al. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998;88(2):288–91.CrossRefPubMedCentralPubMed Swinburn BA, Walter LG, Russell DG, et al. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998;88(2):288–91.CrossRefPubMedCentralPubMed
19.
go back to reference Phillips EM, Kennedy MA. The exercise prescription: a tool to improve physical activity. PM R. 2012;4(11):818–25.CrossRefPubMed Phillips EM, Kennedy MA. The exercise prescription: a tool to improve physical activity. PM R. 2012;4(11):818–25.CrossRefPubMed
21.•
go back to reference Peek ME, Ferguson MJ, Chin MH, et al. Putting theory into practice: a case study of diabetes-related behavioral change interventions on Chicago’s south side. Health Promot Pract. 2014;15(2 Suppl):40S–50. This article describes the importance of community linkages in diabetes care to vulnerable populations, and describes related behavioral change interventions currently underway. It also describes the Exercise Rx intervention discussed in this paper.CrossRefPubMedCentralPubMed Peek ME, Ferguson MJ, Chin MH, et al. Putting theory into practice: a case study of diabetes-related behavioral change interventions on Chicago’s south side. Health Promot Pract. 2014;15(2 Suppl):40S–50. This article describes the importance of community linkages in diabetes care to vulnerable populations, and describes related behavioral change interventions currently underway. It also describes the Exercise Rx intervention discussed in this paper.CrossRefPubMedCentralPubMed
22.
go back to reference Cruz Y, Hernandez-Lane ME, Bautista CT, et al. The effectiveness of a community health program in improving diabetes knowledge in the Hispanic population: Salud y Bienestar (Health and Wellness). J Community Health. 2013;38(6):1124–31.CrossRefPubMed Cruz Y, Hernandez-Lane ME, Bautista CT, et al. The effectiveness of a community health program in improving diabetes knowledge in the Hispanic population: Salud y Bienestar (Health and Wellness). J Community Health. 2013;38(6):1124–31.CrossRefPubMed
23.
go back to reference Collinsworth AW, Vulimiri M, Snead CA, et al. Effectiveness of a community health worker-led diabetes self-management education program and implications for CHW involvement in care coordination strategies. Diabetes Educ. 2013;39(6):792–9.CrossRefPubMed Collinsworth AW, Vulimiri M, Snead CA, et al. Effectiveness of a community health worker-led diabetes self-management education program and implications for CHW involvement in care coordination strategies. Diabetes Educ. 2013;39(6):792–9.CrossRefPubMed
24.
go back to reference Cummings DM, Lutes LD, Schulman K, et al. EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with type 2 diabetes: design, rationale, and baseline characteristics. Contemp Clin Trials. 2013;36(1):147–53.CrossRefPubMed Cummings DM, Lutes LD, Schulman K, et al. EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with type 2 diabetes: design, rationale, and baseline characteristics. Contemp Clin Trials. 2013;36(1):147–53.CrossRefPubMed
25.
go back to reference Rothschild SK, Martin MA, Avery EF, et al. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. Am J Public Health. 2014;104(8):1540–8.CrossRefPubMed Rothschild SK, Martin MA, Avery EF, et al. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. Am J Public Health. 2014;104(8):1540–8.CrossRefPubMed
26.
go back to reference Ryabov I. Cost-effectiveness of community health workers in controlling diabetes epidemic on the U.S.-Mexico border. Public Health. 2014;128(7):636–42.CrossRefPubMed Ryabov I. Cost-effectiveness of community health workers in controlling diabetes epidemic on the U.S.-Mexico border. Public Health. 2014;128(7):636–42.CrossRefPubMed
27.•
go back to reference Vadheim LM, McPherson C, Butcher MK, et al. Adapted diabetes prevention program lifestyle intervention can be effectively delivered through telehealth. Diabetes Educ. 2010;36(4):651–6. This article describes the Montana DPP program discussed in this paper.CrossRefPubMed Vadheim LM, McPherson C, Butcher MK, et al. Adapted diabetes prevention program lifestyle intervention can be effectively delivered through telehealth. Diabetes Educ. 2010;36(4):651–6. This article describes the Montana DPP program discussed in this paper.CrossRefPubMed
29.
go back to reference Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357(4):370–9.CrossRefPubMed Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357(4):370–9.CrossRefPubMed
30.
go back to reference Piette JD, Resnicow K, Heisler M, et al. A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness. Chron Illn. 2013;9(4):258–67.CrossRef Piette JD, Resnicow K, Heisler M, et al. A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness. Chron Illn. 2013;9(4):258–67.CrossRef
31.
go back to reference Sampat S, Kirschenbaum DS, Krawczyk R, et al. Ya gotta have friends: social support and self-efficacy predict success following immersion treatment. Obesity (Silver Spring). 2014;22(12):2579–85. Sampat S, Kirschenbaum DS, Krawczyk R, et al. Ya gotta have friends: social support and self-efficacy predict success following immersion treatment. Obesity (Silver Spring). 2014;22(12):2579–85.
32.
go back to reference Sawka KJ, McCormack GR, Hawe P, et al. Associations between aspects of friendship networks, physical activity, and sedentary behaviour among adolescents. J Obes. 2014;2014:632689.CrossRefPubMedCentralPubMed Sawka KJ, McCormack GR, Hawe P, et al. Associations between aspects of friendship networks, physical activity, and sedentary behaviour among adolescents. J Obes. 2014;2014:632689.CrossRefPubMedCentralPubMed
33.•
go back to reference Guy S, Ratzki-Leewing A, Gwadry-Sridhar F. Evaluation of a web-based patient portal for chronic disease management. Electron Healthc. Springer Berlin Heidelberg; 2012: 114–21. This article describes the My Diabetes Wellness Portal intervention discussed in this paper. Guy S, Ratzki-Leewing A, Gwadry-Sridhar F. Evaluation of a web-based patient portal for chronic disease management. Electron Healthc. Springer Berlin Heidelberg; 2012: 114–21. This article describes the My Diabetes Wellness Portal intervention discussed in this paper.
34.•
go back to reference Pemu PE, Quarshie AQ, Ofili EO, et al. Socio-demographic psychosocial and clinical characteristics of participants in e-HealthyStrides(c): an interactive ehealth program to improve diabetes self-management skills. J Health Care Poor Underserved. 2011;22(4 Suppl):146–64. This article describes the eHealthyStrides intervention discussed in this paper.CrossRefPubMedCentralPubMed Pemu PE, Quarshie AQ, Ofili EO, et al. Socio-demographic psychosocial and clinical characteristics of participants in e-HealthyStrides(c): an interactive ehealth program to improve diabetes self-management skills. J Health Care Poor Underserved. 2011;22(4 Suppl):146–64. This article describes the eHealthyStrides intervention discussed in this paper.CrossRefPubMedCentralPubMed
35.•
go back to reference Hebden L, Balestracci K, Bauman A, et al. ‘TXT2BFiT’ a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial. Trials. 2013;14:75. This article describes the TXT2BFiT intervention discussed in this paper.CrossRefPubMedCentralPubMed Hebden L, Balestracci K, Bauman A, et al. ‘TXT2BFiT’ a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial. Trials. 2013;14:75. This article describes the TXT2BFiT intervention discussed in this paper.CrossRefPubMedCentralPubMed
36.•
go back to reference Moiduddin A. Public health IT to support chronic disease control. NORC (Bethesda). Report. 2014: 1–33. This article describes the SEDI intervention discussed in this paper. Moiduddin A. Public health IT to support chronic disease control. NORC (Bethesda). Report. 2014: 1–33. This article describes the SEDI intervention discussed in this paper.
38.•
go back to reference Garg A, Marino M, Solomon BS, et al. Addressing families’ unmet social needs within pediatric primary care: the health leads model. Clin Pediatr (Phila). 2012;51(12):1191–3. This article describes early data from the analysis of the Health Leads model intervention.CrossRef Garg A, Marino M, Solomon BS, et al. Addressing families’ unmet social needs within pediatric primary care: the health leads model. Clin Pediatr (Phila). 2012;51(12):1191–3. This article describes early data from the analysis of the Health Leads model intervention.CrossRef
39.•
go back to reference Vasan A, Solomon BS. Use of colocated multidisciplinary services to address family psychosocial needs at an urban pediatric primary care clinic. Clin Pediatr (Phila). 2015;54(1):25–32. This article describes subsequent data from the analysis of the Health Leads model intervention.CrossRef Vasan A, Solomon BS. Use of colocated multidisciplinary services to address family psychosocial needs at an urban pediatric primary care clinic. Clin Pediatr (Phila). 2015;54(1):25–32. This article describes subsequent data from the analysis of the Health Leads model intervention.CrossRef
40.•
go back to reference Hassan A, Blood EA, Marmon G, et al. Youths’ health-related social problems: concerns often overlooked during the medical visit. J Adolesc Health. 2013;53(2):265–71. This article describes data from the analysis of the HelpSteps model intervention.CrossRefPubMed Hassan A, Blood EA, Marmon G, et al. Youths’ health-related social problems: concerns often overlooked during the medical visit. J Adolesc Health. 2013;53(2):265–71. This article describes data from the analysis of the HelpSteps model intervention.CrossRefPubMed
41.
go back to reference Fleegler EW, Lieu TA, Muret-Wagstaff S, et al. Families’ health-related social problems and missed referral opportunities. Pediatrics. 2007;119(6):e1332–41.CrossRefPubMed Fleegler EW, Lieu TA, Muret-Wagstaff S, et al. Families’ health-related social problems and missed referral opportunities. Pediatrics. 2007;119(6):e1332–41.CrossRefPubMed
44.
go back to reference Dahrouge S, Hogg W, Kristjansson E, et al. Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter? BMI Health Serv Res. 2013;13:517.CrossRef Dahrouge S, Hogg W, Kristjansson E, et al. Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter? BMI Health Serv Res. 2013;13:517.CrossRef
45.•
go back to reference Burwell SM. Setting value-based payment goals: HHS efforts to improve U.S. health care. N Engl J Med. 2015. This article describes the shift in health care services to value-based payment systems, a key policy change that will largely influence health services linkages to community resources moving forward. Burwell SM. Setting value-based payment goals: HHS efforts to improve U.S. health care. N Engl J Med. 2015. This article describes the shift in health care services to value-based payment systems, a key policy change that will largely influence health services linkages to community resources moving forward.
48.
49.
go back to reference Curtis AB, Kothari C, Connors E, et al. Using GIS and secondary data to target diabetes-related public health efforts. Public Health Rep. 2013;128(3):212–20.PubMedCentralPubMed Curtis AB, Kothari C, Connors E, et al. Using GIS and secondary data to target diabetes-related public health efforts. Public Health Rep. 2013;128(3):212–20.PubMedCentralPubMed
50.
go back to reference Fortney JC, Pyne JM, Schroeder GW, et al. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013;170(4):414–25.CrossRefPubMed Fortney JC, Pyne JM, Schroeder GW, et al. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013;170(4):414–25.CrossRefPubMed
51.
52.
go back to reference Katzman JG, Comerci Jr G, Olivas C, et al. Innovative telementoring for pain management: project ECHO pain. J Contin Educ Health Prof. 2014;34(1):68–75.CrossRefPubMed Katzman JG, Comerci Jr G, Olivas C, et al. Innovative telementoring for pain management: project ECHO pain. J Contin Educ Health Prof. 2014;34(1):68–75.CrossRefPubMed
53.
go back to reference Nundy S, Mishra A, Peek ME. How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. Diabetes Educ. 2014;40(6):806–19.CrossRefPubMed Nundy S, Mishra A, Peek ME. How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. Diabetes Educ. 2014;40(6):806–19.CrossRefPubMed
Metadata
Title
Linking Community Resources in Diabetes Care: a Role for Technology?
Authors
Elizabeth L. Tung
Monica E. Peek
Publication date
01-07-2015
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 7/2015
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-015-0614-5

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