title: Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes.
abstract: BACKGROUND
  Despite the recognized importance of lifestyle modification in reducing risk of developing type 2 diabetes and in diabetes management, the use of available community resources by both patients and their primary care providers (PCPs) remains low. The patient navigator model, widely used in cancer care, may have the potential to link PCPs and community resources for reduction of risk and control of type 2 diabetes. In this study we tested the feasibility and acceptability of telephone-based nonprofessional patient navigation to promote linkages between the PCP office and community programs for patients with or at risk for diabetes.
  
  
  METHODS
  This was a mixed-methods interventional prospective cohort study conducted between November 2012 and August 2013. We included adult patients with and at risk for type 2 diabetes from six primary care practices. Patient-level measures of glycemic control, diabetes care, and self-efficacy from medical records, and qualitative interview data on acceptability and feasibility, were used.
  
  
  RESULTS
  A total of 179 patients participated in the study. Two patient navigators provided services over the phone, using motivational interviewing techniques. Patient navigators provided regular feedback to PCPs and followed up with the patients through phone calls. The patient navigators made 1028 calls, with an average of 6 calls per patient. At follow-up, reduction in HbA1c (7.8 ± 1.9% vs 7.2 ± 1.3%; P = .001) and improvement in patient self-efficacy (3.1 ± 0.8 vs 3.6 ± 0.7; P < .001) were observed. Qualitative analysis revealed uniformly positive feedback from providers and patients.
  
  
  CONCLUSIONS
  The patient navigator model is a promising and acceptable strategy to link patient, PCP, and community resources for promoting lifestyle modification in people living with or at risk for type 2 diabetes.
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham. nloskutova@hotmail.com.
authors.forename: Natalia Y
authors.initials: NY
authors.lastname: Loskutova
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tsai
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Edwin B
authors.initials: EB
authors.lastname: Fisher
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Debby M
authors.initials: DM
authors.lastname: LaCruz
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cherrington
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: T Michael
authors.initials: TM
authors.lastname: Harrington
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Tamela J
authors.initials: TJ
authors.lastname: Turner
authors.affiliation: From the American Academy of Family Physicians National Research Network, Leawood, KS (NYL, WDP); the Division of General Internal Medicine (AGT) and the Department of Family Medicine (WDP), University of Colorado School of Medicine, Aurora; Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill (EBF); YMCA of Greater Birmingham, Birmingham, AL (DML); and the Department of Medicine (ALC) and the Department of Family and Community Medicine (TMH, TJT), University of Alabama at Birmingham, Birmingham.
authors.forename: Wilson D
authors.initials: WD
authors.lastname: Pace
mesh_terms: D000328:Adult; D000407:Alabama; D055812:Community-Based Participatory Research / Q000379:methods / Q000458:organization & administration; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods; D010344:Patient Advocacy; D062526:Patient Navigation / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011369:Professional-Patient Relations; D015397:Program Evaluation; D011446:Prospective Studies; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods; D012648:Self Care / Q000379:methods / Q000523:psychology*
keywords: Community-based Participatory Research; Diabetes Mellitus; Practice-based Research; Self Care