876-P: Peer Support in Primary Care through the Shanghai Integration Model

Abstract

Peer support (PS) is effective in promoting diabetes management, but needs pragmatic models for implementation. The Shanghai Integration Model links specialty/hospital care with primary care in Community Health Centers (CHCs), providing an organizational base for PS. This study reports formative evaluation, implementation and effectiveness of PS within the Shanghai model. The intervention emphasizes diet, physical activity, and insulin/medication use and addresses barriers to management and quality of life. Formative evaluation (3 focus groups, interviews with 15 CHC staff and patients, monthly consultation with CHC staff) led to emphases on group rather than individual PS with theme-based, interactive activities co-led with CHC staff. Peer leaders also follow-up with patients and organize neighborhood activities for physical activity, healthy diet, and comradery. In 9 CHCs, 74 volunteers trained as peer leaders reached 1284 adults (means: age = 68, years with diabetes = 11.8, HbA1c = 7.52%; % on insulin = 33.5%, oral medications = 76.2%). Counter to common difficulty reaching men, 43.1% are male. Two researchers familiar with each CHC rated implementation on 10 features (e.g., activities led by peer leaders) yielding low/medium/high PS implementation (3 CHCs each). Baseline to 12 months, levels of implementation differed on changes in HbA1c -- low: +0.07 points, medium: -0.17, high -0.18 (p < 0.001, controlling for initial HbA1c). For those with initial HbA1c > 8%, changes were more pronounced: -0.28, -1.01, and -0.86 points (p = 0.001, controlling initial HbA1c). Greater implementation was also associated with reductions in BMI (r = -.17) for those with baseline BMI over 26, and reductions in diabetes distress (r = -.20) and pain/negative emotion (r = -.14) among those elevated (top 33%) on these (ps ≤ 0.007). Peer support is feasible in CHCs. Extent of implementation is associated with improved glucose control, especially among those in poor control, as well as other clinical and quality-of-life indicators. Disclosure P.Y. Tang: None. Y. Liu: None. M.M. Coufal: None. Y. Qian: None. C. Cai: None. E.B. Fisher: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Merck Foundation, Novo Nordisk Inc., Sanofi. W. Jia: None. Funding Merck & Co., Inc. Foundation; Sanofi China; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)