Diabetes incurs the most expensive annual chronic disease-related health care costs and certain ethnic groups, such as Latinos, are disproportionately affected by the burden of Type 2 Diabetes Mellitus (T2DM). Patients with T2DM also have comorbid chronic conditions that create complexities for proper management, and have implications for future research on integrating primary and behavioral care, particularly in dis- advantaged groups. Cost-effective, sustainable, and patient-centered adaptations of evidence-based approaches to chronic disease management are needed to meet the needs of the most vulnerable, low- resource communities. Integrated Health Care is the care that results from a practice team of primary care and behavioral health clinicians working together with patients and using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health conditions, health behaviors, life stressors and crises, and clinical outcomes. Care integration is a cornerstone of effective integrated health care that leads to improved clinical and quality of life outcomes and reduces health-care costs and hospitalizations, especially in vulnerable populations. The goal of this project is to improve integrated care services at a federally-qualified Community Health Center (CHC). Latinos Understanding the Need for Adherence in Diabetes (LUNA-D), is a randomized controlled trial that will test the effectiveness of an integrated behavioral health and primary cae chronic care disease management intervention for low income T2DM Latino patients with 2 or more chronic conditions accessing care within San Ysidro Health Center (SYHC). The study aims are to: 1) improve glycemic control, 2) improve cardiovascular risk profiles, 3) decrease psychological distress, and 4) evaluate the patient and provider acceptability and sustainability of the program. LUNA-D will recruit 414 non-insulin using adult T2DM patients with 2 or more chronic diseases. Half will be randomized to the Special Intervention (SI) and half to Usual Care (UC). The SI is a 3-month intensive intervention including fully integrated clinical visits with a mid-level provider (MLP) co-located with a behavioral health counselor (BHC) and peer-led evidence-based group health education sessions and proactive care coordination. Following the intense intervention period, the SI will receive booster sessions and fully integrated MLP/BHC clinical visits across 9 additional months. Usual Care is represented by passive appointments with the primary care physician and passive referrals to behavioral health and traditional health education. HbA1C measurements will be taken at baseline, 3-, 6-, 9- and 12-months to detect changes in glycemic control. Clinical lab measures, medication adherence, weight, health behaviors and psychosocial measures will also be obtained across the study. Demonstration of clinical improvement will support adoption by the SYHC.
The proposed Latinos Understanding the Need for Adherence in Diabetes (LUNA-D) study, will conduct research that aims to reduce chronic disease disparities for disadvantaged Latino populations along the California-Mexico border region of the United States. LUNA-D proposes to test the ability of a fully integrated behavioral health and primary care multiple chronic disease management intervention in a federally-qualified community health care setting to improve multiple clinical and behavioral outcomes.