Kathleen Tarr, M.D., Ph.D
Project Overview:
This study will focus on whether peer coaches contribute to improved diabetes management, patient-physician communication, and metabolic control. It has four main objectives: to increase physician knowledge and adherence to ADA standards of care through education and tools; to improve communication between physicians and patients who have diabetes; to improve diabetes self-management among patients; and to decrease morbidity and mortality from diabetes.
An interactive teaching session will take place for one physician group, who will also receive a pocket card with an outline of current diabetes care guidelines. Peer coaches will be trained to support patients in various aspects of diabetes self-management. Patients with diabetes will be randomly assigned to receive peer coaching or no coach. The no-coach group will serve as controls for the coaching intervention. Patients with diabetes seen in a second physician group who will not receive the training (usual care) will serve as controls to test the effects of physician education.
Final Report:
Diabetes is both prevalent in society, and responsible for significant morbidity and mortality. It is characterized by long-term sequelae on both the micro and macrovascular levels. Minority groups share a disproportionate burden. Strict control of blood sugar can decrease the prevalence and severity of these complications, yet strict glycemic control requires close attention to a multiple behaviors including diet, physical activity, blood sugar monitoring, medication use and multiple appointments with health care providers. Many people are faced with barriers that that make these behaviors difficult. This study proposed an innovative approach to the treatment of chronic illness, specifically diabetes, with the introduction of peer coaches as a complementary resource to the primary care setting. The specific goals were to use peer coaches to provide social support and help institute diabetes self-management utilizing individual readiness to change. The coach, along with an educational program, sought to increase physician attention to diabetes care using feedback, cues and reminders. It was hypothesized that these methods would lead to improved glycemic control, diabetes knowledge and quality of life in adult diabetic patients. As a pilot program, this study was to serve to address the feasibility of the approaches and methods utilized. Preliminary data analysis showed improved glycemic control as measured by a decrease in HbA1c from baseline to follow-up in patients working with a peer coach. Weight was also decreased in this group as opposed to weight gain in the other groups. In addition, the program was well received by both patients and physicians. Social support data indicate that many participants were at risk for poor outcomes due to social isolation. The coach was found to provide support to these individuals. These findings have implications for improved health outcomes in these at risk patients. Future studies will address these issues.
