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首页> 外文期刊>Journal of general internal medicine >Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians' Perspectives
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Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians' Perspectives

机译：将社区卫生工作者纳入安全净初级保健糖尿病预防：对临床医生的观点进行定性分析

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BackgroundEvidence shows community health workers (CHWs) can effectively deliver proven behavior-change strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known.ObjectiveTo examine clinicians' perceptions about working with CHWs for diabetes prevention in safety-net primary care.SettingClinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes.DesignGuided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians' perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n=18) and a 20-item survey (n=54).ApproachBoth survey and interview questions covered clinicians' perspectives on diabetes prevention, attitudes and beliefs about CHWs' role, expectations in working with CHWs, and use of clinic- and community-based diabetes- prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis.Key ResultsEighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs' cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs' training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs.ConclusionsClinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs' effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.
机译：背景技术表明社区卫生工作者（CHW）可以有效地提供经过验证的行为变更策略，以防止2型糖尿病（糖尿病），并加强少数民族和低收入人口初级保健的预防性监护力。但是，将CHW集成为初级保健实践的运营细节仍然不那么众所周知。博伊米检测剂研究了临床医生对使用CHW的CHW用于预防安全净初级保健的糖尿病预防。暂行师是初级保健医师和医院在两个纽约市安全网的初级保健医生和护士医院参加和弦（社区健康外展减少糖尿病）。 Chord是一种集群随机试验，测试CHW干预以防止糖尿病。通过综合实施研究的综合框架设计，研究了CHW模型和初级保健实践的组织背景的特征如何影响临床医生对可接受性，适当性的观点，和糖尿病预防CHW计划的可行性。使用半结构化访谈（n = 18）和20项调查（n = 54）.Approachboth调查和面试问题所涵盖了临床医生的视角，对Chws的角色，期望在使用CHWS，以及使用基于临床和社区的糖尿病预防资源。调查响应已被描述。采访通过组合进行了编码的专题分析的组合来编码.Key效果-7％的调查受访者约定CHW可以帮助预防糖尿病; 83％报告的兴趣与CHW合作。百分之九十一度意识到基于诊所的预防资源;只有11％的人意识到社区资源。临床医生支持CHWS的文化能力和邻里，但对CHWS培训的充分感表示关切;公众和专业重点对预防糖尿病治疗;并添加工作量和与chws的沟通.Conclusionsclinicians发现适合于安全网设置中预防糖尿病的CHW。然而，需要传播关于CHWS的有效性和运营的高质量证据来克服对初级保健中CHW的担忧。

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