The way health care is done in American Samoa may resonate with the way it's done in South Los Angeles.
More than one in five adults in the Pacific U.S. territory have type 2 diabetes, and researchers wanted to gauge the best way to care for them. So, for a study appearing in the journal Diabetes Care, they divided more than 250 diabetic Samoans into two groups:
- A group that received traditional primary care.
- A group that, in addition to primary care, received a "culturally-tailored intervention" from a team of community health workers led by a nurse.
Members of the latter group were visited by community health workers either weekly, monthly or quarterly, depending on the severity of the patient's diabetes. The workers would not only test, but explain blood sugar readings, as well as remind patients to keep up with diets, exercise habits and visits to their health provider. When patients encountered a problem, workers trained them to deal with it, rather than just fixing it for them.
After a year, the participants who were visited by community health workers had healthier blood sugar readings than their counterparts who'd only maintained a normal primary care regimen.
Tailored care and cultural competence
Researchers said the use of the community health workers was an effective way to further extend the reach of a small, already overextended medical staff.
"We believe the findings here may also be generalizable to other diabetes patients in resource-poor and high-risk populations," they wrote.
Or other patients in general. In South L.A., about 12 percent of adults have diabetes – but other chronic conditions, like obesity and high blood pressure, are more than common, too.
Louise McCarthy, the president and CEO of the Community Clinic Association of Los Angeles County, said this model of care will play a big role in improving the southside's quality of life.
"We recognize that the burden of dealing with chronic disease really falls beyond the four walls of just the clinic," she said.
McCarthy explained the role of promotoras – "health promoters."
"These are folks that do a lot of outreach, they do a lot of education," she said. "They're really effective when you're looking at increasing enrollment for [clinic] programs. They're going to be absolutely essential when it comes to people in the community understanding there are places they can go to get well and get care."
Promotoras "provide a level of cultural competence" to the clinic's work, said McCarthy, that gives health providers a critical level of credibility among community members.
"It's getting down to the neighborhoods and communities that these clinics serve," she said, "and actually engaging folks where they are" – whether that's in their homes, workplace or schools. "That's a place where we see just a natural connection for community health."
Even back at the clinic, said McCarthy, health care is hardly "limited to seeing your doctor." For example, she said, when medical assistants know a patient is diabetic, they'll make that patient take off his or her socks and shoes, in order to ensure that the doctor screens his or her feet – a common problem area for people with diabetes.
It's all part of creating what McCarthy calls a "health home."
"It's really that coordination and collaboration," she said. And it's knowing what the clinics can and can't provide. When a clinic can't provide a certain service, said McCarthy, its new job becomes to link a patient to somewhere that can.