PT  - JOURNAL ARTICLE
AU  - Robert L. Ferrer
AU  - Carolina Gonzalez Schlenker
AU  - Inez Cruz
AU  - Polly Hitchcock Noël
AU  - Raymond F. Palmer
AU  - Ramin Poursani
AU  - Carlos Roberto Jaén
TI  - Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care
AID  - 10.1370/afm.2848
DP  - 2022 Sep 01
TA  - The Annals of Family Medicine
PG  - 438--445
VI  - 20
IP  - 5
4099  - http://www.annfammed.org/content/20/5/438.short
4100  - http://www.annfammed.org/content/20/5/438.full
SO  - Ann Fam Med2022 Sep 01; 20
AB  - PURPOSE Improving patients’ self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabetes mellitus (T2DM).METHODS This cohort study, in a safety-net primary care practice, enrolled patients with uncontrolled T2DM and psychosocial risk factors. Patients were identified through a practice diabetes registry or by clinicians’ referrals. The CHWs engaged patients in trust building and sensemaking to understand their social context, identify goals, navigate health care, and connect to community resources. Primary outcome was progress through 3 prospectively defined stages of self-care: outreach (meeting face-to-face); stabilization (collaborating to address patients’ life circumstances); and self-care generativity (achieving self-care competencies). Secondary outcomes were change in hemoglobin A1c (HbA1c) and need for urgent care, emergency department, or hospital visits.RESULTS Of 986 participating patients, 27% remained in outreach, 41% progressed to stabilization, and 33% achieved self-care generativity. Repeated measures ANOVA demonstrates an overall decline in HbA1c, without group differences, through the 4th HbA1c measurement (mean follow-up 703 days). Beginning at the 5th HbA1c measurement (mean 859 days), the self-care generativity group achieved greater declines in HbA1c, which widened through the 10th measurement (mean 1,365 days) to an average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% in the stabilization group (P = .003). Rates of emergency department and hospital visits were lower in the self-care generativity group.CONCLUSIONS Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.