Continuity of Care and Lifestyle Intervention Programs for Spanish-Speaking Immigrants Without Health Insurance at a...

We conducted a retrospective cohort study to evaluate changes in metabolic biomarkers among participants in Bridging the [Health Equity] Gap (BTG), a free program run by Clínica Esperanza/Hope Clinic (CEHC) for Spanish-speaking immigrants without health insurance in Rhode Island.

From July 2019 through June 2021, 471 people volunteered to participate in the BTG program. Participants enrolled in lifestyle change classes and visited quarterly with health care providers. We reviewed medical records to collect data on blood glucose, total cholesterol, hemoglobin A_1c (HbA_1c), and systolic and diastolic blood pressure at baseline and at 6, 12, 18, and 21 months after enrollment. We used paired t tests to identify changes in measurements and conducted a regression analysis to analyze trends in longitudinal patient outcomes.

From baseline to 6-month follow-up, we observed significant decreases in all participants' mean HbA_1c (-0.71%), systolic (-5 mm Hg), and diastolic blood pressure (-2 mm Hg). At 12 months, significant decreases in mean HbA_1c persisted among participants with diabetes and prediabetes (-1.07%). At 12 months, participants with mean systolic blood pressure >120 mm Hg also had significant decreases in mean systolic blood pressure (-9 mm Hg), and patients with diastolic blood pressure >80 mm Hg had significant decreases in mean diastolic blood pressure (-9 mm Hg). Local population-level surges in COVID-19 due to Delta and Omicron variants were associated with increases in HbA_1c and blood glucose measurements above trendlines.

The BTG program demonstrated resilience in supporting improvement in the metabolic biomarkers of participants, despite disruptions caused by the COVID-19 pandemic, the continued engagement of participants in self-care despite limited health care access, and underscores the positive role of free clinics among low-income, Spanish-speaking immigrants.