MedWire News: Study results show that a culturally tailored intervention program allows African–American individuals with Type 2 diabetes to reduce the number of times they need to visit the emergency care room (ER) of their local hospital.

African–American individuals are almost twice as likely to have Type 2 diabetes and its accompanying complications as the majority of the US population.

In this study, Tiffany Gary (John Hopkins Medical Institutions, Baltimore, Maryland, USA) and team sought to discover whether an intensive, tailored community intervention would help improve the lifestyle and reduce the emergency care needs of 542 urban African Americans with Type 2 diabetes compared with minimal intervention.

More specifically, 273 participants were assigned to a minimal intervention program involving usual diabetes care, plus a telephone call every 6–12 months to remind participants about preventive screenings, and educational mail outs every 3–4 months.

In the intensive intervention group, 269 patients were assigned to the same care as the minimal intervention group plus individualized and culturally tailored additional care provided by a nurse case manager and a community health worker, which involved both home and clinic visits 1–3 times per year.

The participants were followed-up at 24 and 36 months. At 24 months, participants in the intensive intervention group were 23% less likely to visit their local ER than patients in the minimal intervention group, at 404 versus 322 ER visits, respectively. There were also slightly more hospitalizations in the minimal versus intensive intervention groups at 273 versus 269.

The team reports that the greatest rate reduction at 24 months, 34%, was observed for participants in the intensive intervention group who received the most nurse case manager and community health worker visits.

Similar results were seen at 36 months. Of note, community health worker visits, but not necessarily nurse case manager visits, were associated with a significant 47% reduction in ER visits at 36 months in the intensive intervention group compared with the minimal intervention group.

“Contributing factors to health disparities are multifactorial in nature and include patient behavior and characteristics (eg, adherence and health literacy), physician behavior (eg, treatment threshold and target), and health care system factors (eg, access to care and continuity of care),” write Gary and colleagues in the Archives of Internal Medicine.

They conclude that their results give support for the use of an intensive intervention strategy to reduce emergency unit care in high-risk, minority, and urban populations.

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