Diabetes management for low-income patients in Los Angeles: two strategies improved disease control in the short term.
Health care providers serving vulnerable patients in Los Angeles have developed programs intended to increase diabetes control through more-intensive patient education and engagement. We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as "bad" cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and cost effects.
RAND Corporation, Santa Monica, California, USA. huckfeld@rand.org
Peter J
PJ
Huckfeldt
Daniella
D
Meeker
Anne
A
Peters
Jeffrey J
JJ
Guterman
Guillermo
G
Diaz
Dana P
DP
Goldman
D019090:Case Management; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010593:Pharmaceutical Services; D011203:Poverty