This study evaluates the effectiveness of community health workers when added to routine care for patients with diabetes and high blood pressure in rural clinics in Chiapas, Mexico. It does so by recording information on adherence to therapy, blood pressure and hemoglobin A1c while a non-governmental organization working in Mexico trains and introduces a community health worker program.
Compañeros en Salud (CES), an affiliate project of Partners in Health, has been working in the rural Sierra of Chiapas, Mexico since February 2012. CES works in partnership with the local Ministry of Health to rehabilitate and staff existing government primary care clinics. Each community's clinic is staffed by one CES project physician year-round. CES activities span the range of allopathic medicine, but the focus of the project is in the prevention, detection, diagnosis and management of non-communicable diseases (NCDs) such as diabetes and hypertension. CES currently operates in several rural communities with catchment areas of approximately 1,500 - 2,500 people. Routine care for NCDs is based on national guidelines and consists of monthly in-clinic visits by primary care physicians. Over 9 months in 2014 and again over 6 months in 2016, CES will introduce a community health worker program called "Acompañantes" to its project communities to augment care of patients with NCDs. Acompañantes are lay health workers and members of the community who bridge the gap between project clinics and patients, improving understanding of NCDs, their treatments, and adherence to therapy. The introduction of Acompañantes to communities is planned in a once-every-three-months fashion, the most rapid roll-out logistically feasible for CES. The investigators' project will document their experience over this time, and for one year after introduction of the Acompañantes program to all seven study communities, by documenting adherence to therapy, hemoglobin a1c, and blood pressure at every-three month intervals over this time frame.
Study Type
OBSERVATIONAL
Enrollment
168
Brigham and Women's Hospital
Boston, Massachusetts, United States
Change in Hemoglobin A1c
Change in percent glycated hemoglobin as measured by PTS diagnostics point-of-care assay
Time frame: Baseline, 23 months
Change in Systolic Blood Pressure
Change in Systolic blood pressure as measured by Omron HEM 7080IT electronic blood pressure monitor
Time frame: Baseline, 23 months
Change in Adherence to Daily Medications
Change in self-reported medication adherence as measured by 5-day recall, 30-day recall and response to Likert-style questions
Time frame: One year after all communities receive intervention
Change in Diastolic Blood Pressure
Change in diastolic blood pressure as measured by Omron HEM 7080IT electronic blood pressure
Time frame: Baseline, 23 months
Disease Control
Diabetes and/or hypertension control. Disease control among patients with hypertension was defined according to Mexican national guidelines: blood pressure \<140/90 mm Hg for patients with hypertension and no diabetes; blood pressure \<130/80 mm Hg for patients with hypertension and diabetes and blood pressure \< 150/90 mm Hg for patients over the age of 80. Disease control for patients with diabetes defined as glycated hemoglobin (HbA1c) \< 7% per national guidelines.
Time frame: One year after all communities receive intervention
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