Arshiya A. Baig

The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients.

Differences in rates of diabetes-related lower extremity amputations represent one of the largest and most persistent health disparities found for African Americans and Hispanics compared with Whites in the United States. Since many minority patients receive care in underresourced settings, quality improvement (QI) initiatives in these settings may offer a targeted approach to improve diabetes outcomes in these patient populations. Health information technology (health IT) is widely viewed as an essential component of health care QI and may be useful in decreasing diabetes disparities in underresourced settings. This article reviews the effectiveness of health care interventions using health IT to improve diabetes process of care and intermediate diabetes outcomes in African American and Hispanic patients. Health IT interventions have addressed patient, provider, and system challenges in the provision of diabetes care but require further testing in minority patient populations to evaluate their effectiveness in improving diabetes outcomes and reducing diabetes-related complications.

Family interventions to improve diabetes outcomes for adults

Diabetes self‐care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patients disease management, involving them in self‐care interventions may positively influence patients’ diabetes outcomes. We systematically reviewed family‐based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients’ diabetes outcomes and the extent of family involvement. We found 26 studies describing family‐based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients’ self‐efficacy, perceived social support, diabetes knowledge, and diabetes self‐care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients’ clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement.

“One Can Learn From Other People’s Experiences” Latino Adults’ Preferences for Peer-Based Diabetes Interventions

Purpose To assess Latino adults’ preferences for peer-based diabetes self-management interventions and the acceptability of the church setting for these interventions. Methods The authors partnered with 2 predominantly Mexican American churches in Chicago and conducted 6 focus groups with 37 adults who had diabetes or had a family member with diabetes. They assessed participant preferences regarding group education and telephone-based one-to-one peer diabetes self-management interventions. Systematic qualitative methods were used to identify the types of programming preferred by participants in the church setting. Results Participants had a mean (SD) age of 53 (11) years. All participants were Latino, and more than half were born in Mexico (60%). Most participants were female (78%), had finished high school (65%), and had health insurance (57%). Sixty-five percent reported having a diagnosis of diabetes. Many participants believed the group-based and telephone-based one-to-one peer support programs could provide opportunities to share diabetes knowledge. Yet, the majority stated the group education model would offer more opportunity for social interaction and access to people with a range of diabetes experience. Participants noted many concerns regarding the one-to-one intervention, mostly involving the impersonal nature of telephone calls and the inability to form a trusting bond with the telephone partner. However, the telephone-based intervention could be a supplement to the group educational sessions. Participants also stated the church would be a familiar and trusted setting for peer-based diabetes interventions. Conclusions Church-based Latinos with diabetes and their family members were interested in peer-based diabetes self-management interventions; however, they preferred group-based to telephone-based one-to-one peer programs.

Services Delivered by Faith-Community Nurses to Individuals With Elevated Blood Pressure

OBJECTIVE Our study describes the services faith-community nurses provide to a community-dwelling sample of patients with elevated blood pressure. DESIGN AND SAMPLE The faith-community nurses completed a survey describing services provided to study participants at each patient encounter. We describe the type of contact and the frequency and types of services provided to these patients. From October 2006 to October 2007, we conducted a partnered study with a faith-community nursing program and enrolled 100 adults with elevated blood pressure from church health fairs. MEASURES Patient demographics and faith-community nurse services provided. RESULTS Data from 63 of 108 (58%) visits to faith-community nurses made by 33 participants were collected from surveys completed by the nurses. The majority of the participants were female (64%), Latino (61%), with an average age of 59 (SD=11) years and incomes below US

Provider Barriers and Facilitators to Screening for Intimate Partner Violence in Bogotá, Colombia

30,000 (83%). The most frequent services patients received from faith-community nurses were blood pressure measurement (73%), hypertension-specific education on dietary changes (67%), and supportive counseling (56%). CONCLUSIONS Faith-community nurses represent a new method of supportive self-management for low-income individuals with a chronic condition who may otherwise have limited access to health services. Further research is needed to understand the effect of faith-community nurse interventions on improving chronic disease health outcomes in these communities.

Community Health Center Provider and Staff's Spanish Language Ability and Cultural Awareness

We conducted interviews with 27 health care personnel in Bogotá, Colombia, to examine provider barriers and facilitators to screening for intimate partner violence (IPV). We used systematic qualitative analysis to identify the range and consistency of beliefs. We found that respondents did not routinely screen for IPV. Providers listed numerous barriers to screening. Ways to improve screening included increased clinician training, installing systematic IPV screening, providing patient education, and implementing health care setting interventions. Improving the care for IPV survivors will involve translating health care personnel preferred solutions into more systematic IPV screening interventions.

Diagnosing diabetes in disadvantaged populations: the role of social participation

Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76–100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients.

High Stakes for the Health of Sexual and Gender Minority Patients of Color

Objective: Extensive social networks improve health and reduce mortality. Our aim was to investigate the effect of social participation on the probability that people with diabetes are diagnosed by health care providers and whether these effects differ in disadvantaged populations. Methods: Using the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we included 1642 adults with diabetes. Diagnosed people with diabetes reported a provider diagnosis of diabetes; undiagnosed people with diabetes had a fasting plasma glucose over 125 mg/dl. Multivariate logistic regression models were used to assess the effect of social participation on diabetes diagnosis. Results: Increased social participation led to a higher probability of being diagnosed among people with diabetes who were low-income (OR 5 1.19, P < 0.10) and who did not graduate from high school (OR 5 1.21, P < 0.05). Conclusions: People with diabetes who had low incomes and who did not graduate from high school were more likely to know they had diabetes if they had more frequent social interaction. Clarifying the mechanisms through which social participation affects the diagnosis of diabetes may help in developing strategies to improve diabetes identification.

International Examples of Undocumented Immigration and the Affordable Care Act

As clinicians, educators, and researchers, our ability to provide the best possible care to our patients who are sexual and gender minority (SGM) people of color is increasingly challenged. Relative to the general population, SGM patients often have worse health outcomes, and among SGM patients, racial and ethnic minorities are particularly vulnerable. Healthcare policies proposed by the current administration, along with an increasingly hostile and dangerous social climate, have the potential to seriously harm SGM patients of color. In this paper, we discuss these key policy issues impacting the health of SGM patients of color. We then suggest questions for clinicians to consider to help them decide which advocacy activities are right for them, recommending self-examination, skills development, and political action. We end by outlining concrete, actionable steps to advocate for SGM patients of color in patient care, healthcare organizations, medical education, research, and public policy.

A Randomized Community-based Intervention Trial Comparing Faith Community Nurse Referrals to Telephone-Assisted Physician Appointments for Health Fair Participants with Elevated Blood Pressure

As it stands there is no viable health care option for undocumented immigrants of low socioeconomic status. Even more worrisome is that Affordable Care Act simply does not address this issue with any direct plan. The US is in a very influential time period in terms of undocumented immigration and its relationship with health care. The purpose of this paper is to examine international examples of undocumented immigrant health care and their implications for the United States’ undocumented immigrant health care. This study found that physicians in the US must work to prevent the initiation of policies which exclude undocumented immigrants from accessing health care. Exclusionary policies implemented in European nations have had disastrous effects on physicians and patients. This paper examines the implications which similar policies would have if implemented in the US.