Diabetes Management for Low-Income Patients in Los Angeles

Two Strategies Improved Disease Control in the Short Term

Published in: Health Affairs, v. 31, no. 1, Jan. 2012, p. 168-176

by Peter J. Huckfeldt, Daniella Meeker, Anne Peters, Jeffrey J. Guterman, Guillermo Diaz, Dana P. Goldman

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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.

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