This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. The proposed adaptation and dissemination project builds on previous research aimed at improving diabetes care quality at a local federally-quality community health center, providing care to this predominately low income, urban African American population. Our intent in this proposed project is to adapt and customize Comparative Effectiveness Research Summary Guides (CERSGs) for Consumers and Clinicians: Consumer Guides """"""""Pills for Type 2 Diabetes"""""""" and """"""""Premix Insulin for Type 2 Diabetes"""""""" and Clinician Guides """"""""Comparing Oral Medications for Adults with Type 2 Diabetes"""""""" and """"""""Premixed Insulin Analogues."""""""" The CERSGs will be adapted within the socio-cultural context of routine provision of care within this healthcare organization (West End Medical Centers (WEMC)) and in doing so impact overall diabetes care quality. The project objective is to incorporate evidence-based medication use into patient self-care, the WEMC Diabetes Self-Management Education (DSME) Program, and the decision support functions of the electronic medical record (EMR) system. The primary aims are to 1) improve the rate of scheduled diabetes care follow-up visits, to enhance the opportunity for anti-diabetes treatment and treatment intensification, 2) increase medication knowledge and awareness, 3) improve patient communication with the provider regarding medication use and 4) improve adherence to CERSGs prescribed medications. The secondary aims are to 1) increase participation and completion rates of WEMC DSME classes where medication adherence behaviors are reinforced and 2) to improve prescription documentation of CERSGs oral and insulin medications in the EMR systems for periodic review and assessment of evidence-based prescribing practice. We propose a community health work (CHW) model with the innovation of motivational interviewing (MI) to deliver the content of CERSGs to adults with type 2 diabetes. The CHW intervention will be delivered according to the psycho-social needs and stage of readiness of the project participants and for the purpose of facilitating motivation for adherence to prescribed anti-diabetes medications. Despite current efforts at WEMC, diabetes care quality remained suboptimal, the missed appointment rate is high and medication adherence is at 20%. Participation in and completion of DSME classes are poor, and care quality and prescribed medications are poorly documented in the EMR system. The CHW intervention is expected to improve the rate of diabetes care follow-up visits, knowledge and aware of evidence-based medication use, patient communication, medication adherence, and participation in DSME classes where medication adherence will be reinforced. Adaptation CERSGs is expected to be further enhanced by incorporating CERSGs for providers into the EMR system, provide web-base training for clinicians, and audit medications problems, and conduct feedback discussion of medication adherence and patient-provider communication issues, e.g., during """"""""Lunch and Learn"""""""" (Figure 1). Two major hypotheses will be tested in this proposed research and dissemination project: 1) the CHW intervention model will increase medication knowledge and awareness, increase patient communication with the provider, reduce medication problems, and improve medication adherence and 2) intrinsic motivation will be actualized among patients assigned to the CHW-MI group, which will results in better medication adherence relative to the patients receiving general diabetes education by the CHW.
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