Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial

Area of Science:

• Primary Care
• Health Services Research
• Chronic Disease Management

Background:

• Improving chronic disease care quality and efficiency is a key healthcare objective.
• Effective strategies are needed to support patients in managing long-term conditions.

Purpose of the Study:

• To evaluate if lay "care guides" improve evidence-based goal achievement for patients with chronic diseases compared to usual care.
• To assess the impact of non-clinician support on patient self-management and health outcomes.

Main Methods:

• A parallel-group randomized trial involving 2135 adult patients with hypertension, diabetes, or heart failure across 6 primary care clinics.
• Patients were assigned 2:1 to receive usual care or support from a trained lay care guide for 1 year.
• The primary outcome was the change in the percentage of evidence-based goals met after 1 year.

Main Results:

• Patients with care guides achieved a significantly higher percentage of goals (82.6%) than those receiving usual care (79.1%).
• The care guide group demonstrated a 30.1% reduction in unmet goals versus 12.6% in the usual care group.
• Improvements were noted in specific goals, including tobacco cessation, with an estimated cost of $286 per patient annually.

Conclusions:

• Integrating care guides into primary care teams can enhance chronic disease management for certain patient populations.
• This intervention offers a cost-effective method to improve patient adherence to evidence-based care goals.
• Lay support personnel can play a valuable role in augmenting traditional healthcare delivery for chronic conditions.