Community Health Center Staff Research Articles

Abstract P406: Transforming Clinical Practices for Blood Pressure Management in Community Health Centers through Timely Data and Technical Support

Introduction: Blood pressure (BP) control can prevent major adverse cardiac events and is monitored through various means, including the Centers for Medicare and Medicaid Services 165 metric for BP control - an annual reporting metric for community health centers (CHCs) within the Uniform Data System framework that becomes accessible 6 months after the conclusion of the reporting period. In pursuit of more immediate indicators related to BP management, the National Hypertension Control Initiative (NHCI) initiated collaboration with a population health platform to support select CHCs with rapidly available data on 19 BP-related metrics. Hypothesis: With technical support and regular access to data, CHCs can implement timely clinical practice and process changes. Methods: To support CHCs in using the population health platform, NHCI staff provided technical assistance in a rapid cycle performance improvement (RCPI) to 10 interested CHCs. This opportunity allowed CHCs to partner with NHCI staff to review BP related metrics in the population health platform and to identify opportunities for clinical process and practice changes. Over an 8-week period from October to December 2023, 7 CHCs were actively involved in a series of 5-6 structured 30–60-minute meetings with both NHCI registered nurse and quality improvement staff. These meetings reviewed BP metrics, mapped clinical workflows for improvement, and supported data analytics. CHCs often chose 1-2 BP metrics for focus, concentrating on incremental change and short-term improvement. Results: Among participating CHCs that reported, they revealed successful or anticipated adjustments in team responsibilities and clinical processes, including leadership involvement and new methods. Limitations included CHC staff engagement, time, concerns with data reliability, and familiarity with the population health platform. Most reporting CHCs shared that their goals were greatly impacted by access to readily available performance data and that they plan to continue using the population health platform to affect performance moving forward. Conclusions: For participating CHCs, individualized guidance based on timely data may have been helpful in analyzing workflows and procedures, assessing clinical care practices, and implementing quality improvement plans. Frequent data may allow CHCs to make clinical practice and process changes to efficiently measure impact and more quickly improve BP control than standard methods.

Improving Emergency Skills: Training Program at Medono Health Center, Pekalongan City

First aid is crucial and essential for providing emergency assistance. Early treatment of injured individuals at home can significantly reduce morbidity and mortality rates. Community health center staff, as primary service providers to the community, must be proficient in first aid since emergencies can happen anytime and anywhere. This study assessed the effectiveness of Cardiopulmonary Resuscitation (CPR) training at the Medono Community Health Center in enhancing the knowledge and skills of healthcare workers. Initially, 76.2% of participants had inadequate knowledge about CPR, but after training, 86% showed a substantial improvement in knowledge. Furthermore, the training reduced errors in using the Bag Valve Mask (BVM) and performing chest compressions. Mistakes in ventilation decreased after proper instruction, and errors in compression positioning dropped from 57.8% to nearly zero. These findings highlight the critical role of CPR training in enhancing the preparedness and competence of healthcare workers in emergencies. The Medono Health Center is dedicated to regularly conducting CPR training to ensure the continuous improvement of healthcare quality and patient safety.

Evaluation of the Muara Satu Community Health Center in Lhokseumawe City's outpatient services' quality utilizing the importance-performance analysis approach and possible increase in customer value

A dynamic state of people, processes, environments, goods, and services that either meet or beyond expectations is known as service quality. It is vital to improve services to compete and provide higher-quality services at the Muara Satu Community Health Center through initiatives to enhance human resources and ongoing performance improvement. The Muara Satu Community Health Center has received major accreditation for its services; however, as of yet, no reassessment has been conducted. The management of Puskesmas wishes to refine the accreditation to become plenary so that patient satisfaction can serve as a gauge of the success of the center's health services provided to the community. This study aims to evaluate the degree of agreement between patient interests and satisfaction and the Muara Satu Community Health Center's service quality performance. Additionally, it seeks to identify the attributes that should be given priority for service improvement through the application of the Potential Gain in Customer Value (PGCV) method. Patients' complaints regarding services, such as uncomfortable waiting rooms and a lack of information about the ailments they were suffering from, posed a challenge for this study. Five categories were created based on 17 characteristics of the patient requests made at the health center and were given to 58 pre-selected samples. This category includes Assurance, Empathy, Tangible, Reliability, and Responsive. The Muara Satu Health Center is required to implement seven priority orders for quality improvement based on the IPA and PGCV methods, based on data processing findings. These orders include requiring the Community Health Center staff to inform patients before providing services, having a comfortable waiting area, and having officers act quickly and appropriately when necessary. Facilities in Puskesmas are fully equipped. The types of ailments, their treatments, and how to take medication are all thoroughly explained by the doctor. Furthermore, physicians allot enough time for patient examinations

Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design.

Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program. The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.

The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia.

The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives. This study investigates the experiences of community health worker and their perception of mental illness. A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment. Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems. Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.

The impact of leadership style in team-based primary care - staff satisfaction and motivation.

Leadership styles, beliefs, and behaviours are an important and critical component to the delivery of quality care in any primary care organisation. The human resource crisis in health care has resulted in greater investments in team-based care; however, some leaders may not have experience working in team-based settings. To explore what leadership characteristics, styles, and behaviours were most conducive to employee satisfaction, motivation, and delivery of care in a team-based primary care setting. A qualitative study involving 16 community health centre (CHC) staff from six CHCs across Ontario, Canada. Thematic analysis of qualitative interviews using a framework based on transformational leadership (TL) theory. The following three themes emerged from our findings as having a noticeable impact on staff motivation, morale, delivery of care, and client outcomes: transparent and open communication; opportunities to collaborate in decision making; and staff recognition and appreciation. The results of our study indicate it is critical that leaders adopt leadership styles and approaches in which every team member is informed, heard, and appreciated. This study described the leadership styles and characteristics that lead to improved employee satisfaction, motivation, and morale in a team-based primary care setting, and the impact this could and does have on quality and delivery of care. Future research is needed to better understand the impact of leadership in a variety of roles within a team-based environment, specifically in a multidisciplinary setting.

Analisis Efektivitas E-Health Menggunakan Metode E-Govqual dan IPA Di Puskesmas Gading Kota Surabaya

E-Health, a public service that leverages Information Technology to enhance the health sector's knowledge base, faces developmental challenges. At Gading Health Center in Surabaya City, dissatisfied assessments of the health center's rating stem from discontent with both services and the e-Health system. Issues include disparities in service time compared to the targeted e-Health Service System queue, as well as variations between online registration times and the actual services provided at the health center. Moreover, human resource factors such as knowledge, experience, and technological skills among Gading Community Health Center staff significantly influence the successful implementation of the e-Health system. This study employs e-GovQual and IPA methods to evaluate the effectiveness of e-Government Implementation, focusing on dimensions like efficiency, trust, reliability, and citizen support. The research findings, analyzing the effectiveness of e-Health at Puskesmas Gading using e-GovQual and IPA methods, lead to the conclusion that the implementation of e-Health at Puskesmas Gading in Surabaya City positively impacts the quality of health services

"An Act of Complete Care": Provider Perspectives on Linking Maternal Contraceptive Care With Well-Baby Visits in Community Health Centers.

Short inter-pregnancy interval (IPI) is associated with adverse health outcomes for women and infants, and low-income women experience disproportionate rates of short IPI. An essential solution is providing postpartum (PP) women with timely contraceptive care. However, patient-centered approaches for facilitating care access are needed. To explore Community Health Center (CHC) staff and provider perspectives on the implementation of a clinical trial offering co-scheduled well-infant/maternal contraceptive care for women with infants 0 to 6 months at the Well-Baby Visit (WBV). Eighteen participants (providers, staff, and administrators) representing 7 diverse CHC sites in 2 U.S. states completed semi-structured telephone interviews. Audio-recordings were transcribed and analyzed using hybrid thematic analysis. Offering co-scheduled visits was perceived as beneficial for facilitating timely PP contraception, convenient care access, and encouraging family planning considerations during the PP period. However, provider and staff discomfort with initiating family planning and contraceptive care conversations at the WBV emerged as a salient barrier. Paired approaches to well-infant/maternal contraceptive care may promote increased access to timely contraception for PP women, possibly reducing unintended short IPI. Comprehensive training, ongoing support, and patient-centered implementation strategies tailored to context and developed with care team input are needed to ensure competency and comfortability with facilitating contraceptive care conversations at the WBV.

Distribution of COVID-19 Home Testing Through Community Health Centers: Results of the COVID CoNOce MÁS Study.

To assess acceptability and feasibility of rapid at-home COVID-19 testing and reporting of test results among individuals seeking care at community health centers (CHCs) and their household members. Participants were recruited from 2 Community Health Centers during a clinic visit or a community event. Over-the-counter COVID-19 tests were distributed to participants for self-testing and to offer testing to household members. Separate surveys were administered to collect baseline information on the study participant and to collect test results on the study participant and household members. We calculated the proportion of individuals who agreed to complete COVID home testing, those who reported test results, and the test positivity. For household members, we calculated the proportion who completed and reported results and the positivity rate. We assessed reasons for undergoing COVID-19 testing and the action taken by participants who reported positive tests. A total of 2189 individuals were approached by CHC staff for participation and 1013 (46.3%) agreed to participate. Among the 959 participants with complete sociodemographic data, 88% were Hispanic and 82.6% were female. The proportion providing test results was 36.2% and the test positivity was 4.2%. Among the 1927 test reports, 35.3% for the index participant and 64.4% were for household members. The largest proportion of test results were for index participants (35.3%) and the second largest was for the participant's children (32.1%), followed by parents (16.9%), and spouse/partner (13.2%). The 2 most common reasons for testing were symptoms (29%) and attending family gatherings (26%). Among test-positive individuals (n = 80), most (83.3%) noted that they isolated but only 16.3% called their provider and 1.3% visited a clinic. Our results show interest in at-home COVID-19 testing of multiple household members, as we headed into the endemic phase of the pandemic. However, reporting of test results was modest and among test-positive individuals, reporting results to a provider was very low. These results underscore the challenges with reporting and following guidelines among people undergoing home testing for COVID-19, which may have implications for future pandemics.

An Analysis Of Medicine Inventory Accounting Information System At Mentiring Health Center On Psap Number 5

This study aims to find out whether the application of the accounting information system that has been implemented in managing drug supplies is running in accordance with PSAP Number 5 and meets the needs at Mentiring Health Center. The type of data used in this research is qualitative comparative data, which is research carried out by comparing a variable in different samples to get answers or facts about whether there is a comparison or not from the research. Data was obtained from field studies through observation, interviews, documentation. The results of the research carried out show that the procedures for implementing the drug inventory accounting system at Mentiring Health Center, the implementation of the drug supply accounting system uses a first-in, first-out (FIFO) system, first-in, first-out and first expired first out (FEFO), but the accounting system and procedures implemented are not yet effective and efficient. This happens because the records used are still manual records so that physical drug inventory data has a very large risk of data damage. Manual records are still carried out because community health center staff are not yet proficient in using computer-based records and are also hampered by the internet network which is difficult to access.

A Healthy Dental Nutrition Card as A Parenting Pattern to Prevent Stunting in Toddlers

Background: The healthy teeth nutrition card (Kartu Nutrisi Gigi Sehat) is a development model for parenting patterns to prevent stunting in toddlers. These cards were developed for young children and are efficient for children and health practitioners to carry and play with. It is hoped that parenting patterns in the form of healthy dental nutrition can prevent caries which affects food intake and nutritional status. The aim of the research is to develop a healthy dental nutrition card as a parenting pattern to prevent stunting in toddlers.&#x0D; Method: This research is Research and Development (R&amp;D), carried out at Posyandu Widuri VI, Paal Lima Village, Jambi City. Media and material validation involved 6 experts. The research subjects were 16 toddlers, 4 cadres, 4 community health center staff, 2 PKK people, and 16 mothers of toddlers. The data collected using questionnaires. &#x0D; Results: Healthy dental nutrition cards are very eligible for use to promote dental health as a parenting pattern to prevent stunting in toddlers.&#x0D; Conclusion: It is recommended that future research test the effectiveness of healthy dental nutrition cards&#x0D; &#x0D;

Costs and Health Care Utilization Analysis of Medical Group Visits for Adults With Type 2 Diabetes in Community Health Centers.

We evaluated the economic impact of group visits (GVs) in adults with uncontrolled diabetes in community health centers (CHCs) in the United States. In this prospective controlled trial, we implemented 6 monthly GV sessions in 5 CHCs and compared intervention patients (n=49) to control patients (n=72) receiving usual care within the same CHCs. We conducted patient chart reviews to obtain health care utilization data for the prior 6 months at baseline, 6 months (during the GV implementation), and 12 months (after the implementation). We also collected monthly logs of CHC expenses and staff time spent on activities related to GVs. Per-patient total costs included CHCs' expenses and costs associated with staff time and patients' health care use. For group comparison, we used the Wilcoxon rank-sum test and the bootstrapping method that was to bootstrap generalized estimating equation models. The GV group had fewer 6-month hospitalizations (mean: GV: 0.06 vs. control: 0.24, rate: 6.1% vs. 19.4%) ( P ≤ 0.04) and similar emergency department visits at 12 months than the control group. Implementing GV incurred $1770 per-patient. The intervention cost $1597 more than the control at 6 months ($3021 vs. $1424) but saved $1855 at 12 months ($857 vs. $2712) ( P =0.002). The diabetes GV care model reduced hospitalizations and had cost savings at 12 months, while it improved patients' diabetes-related quality of life and glucose control. Future studies should assess its lifetime cost-effectiveness through a randomized controlled trial.

"Wanting the Best for Our Folks"-A Mixed Methods Analysis of Community Health Center Social Risk Screening Initiatives.

Many community health centers (CHC) are scaling social risk screening in response to growing awareness of the influence of social adversity on health outcomes and concurrent incentives for social risk data collection. We studied the implementation of social risk screening in Texas CHCs to inform best practices and understand equity implications. Convergent mixed methods of 3 data sources. Using interviews and surveys with CHC providers and staff, we explored social risk screening practices to identify barriers and facilitators; we used electronic health record (EHR) data to assess screening reach and disparities in screening. Across 4 urban/suburban Texas CHCs, we conducted 27 interviews (15 providers/12 staff) and collected 97 provider surveys; 2 CHCs provided EHR data on 18,672 patients screened during the study period. Data revealed 2 cross-cutting themes: 1) there was broad support for social risk screening/care integration that was rooted in CHCs' mission and positionalities, and 2) barriers to social risk screening efforts were largely a result of limited time and staffing. Though EHR data showed screens per month and screens/encounters increased peri-pandemic (4.1% of encounters in 8/2019 to 46.1% in 2/2021), there were significant differences in screening rates by patient race/ethnicity and preferred language (P < .001). In surveys, 90.0% of surveyed providers reported incorporating social risk screening into patient conversations; 28.6% were unaware their clinic had an embedded screening tool. Study CHCs were in the early stages of standardizing social risk screening. Differences in screening reach by patient demographics raise concerns that social screening initiatives, which often serve as a path to resource/service connection, might exacerbate disparities. Overcoming barriers to reach, sustainability, and equity requires supports targeted to program design/development, workforce capacity, and quality improvement.

Community Health Center Staff Perspectives on Financial Payments for Social Care.

A growing crop of national policies has emerged to encourage health care delivery systems to ask about and try to address patients' social risks, e.g., food, housing, and transportation insecurity, in care delivery contexts. In this study, we explored how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams' engagement in these activities. We interviewed 42 clinicians, frontline staff, and administrative leaders from 12 Oregon CHC clinical sites about their social care initiatives, including about the role of existing or anticipated financial payments intended to promote social risk screening and referrals to social services. Data were analyzed using both inductive and deductive thematic analysis approaches. We grouped findings into three categories: participants' awareness of existing or anticipated financial incentives, uses for incentive dollars, and perceived impact of financial incentives on social care activities in clinical practices. Lack of awareness of existing incentives meant these incentives were not perceived to influence the behaviors of staff responsible for conducting screening and providing referrals. Current or anticipated meaningful uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest motivator for clinic social care practices was the ability to provide responsive social services. Clinic leaders/managers noted that for financial incentives to substantively change CHC practices would require payments sizable enough to expand the social care workforce as well. Small fee-for-service payments to CHCs for social risk screening and navigation services are unlikely to markedly influence CHC social care practices. Refining the design of financial incentives-e.g., by increasing clinical teams' awareness of incentives, linking screening to well-funded social services, and changing incentive amounts to support social care staffing needs-may increase the uptake of social care practices in CHCs.

Factors that Play a Role in Community Participation in Creating Healthy Alleys in Makassar City

This research aims to reveal the factors that play a role in community participation in creating Healthy Hallways. This research is qualitative research using a Rapid Assessment Procedures design. The informants for this research were determined using purposive sampling. The data collection technique used in-depth interviews with seven community members: 1 RT head, 1 RW head, 1 Community Health Center staff, two health cadres, and one village head. This research was analyzed using the "Content Analysis" method, then interpreted and presented in narrative and matrix form. The research results found that the factors that play the most role in community participation are the will/awareness and leadership of the local government. Thus, Community Health Center health workers responsible as health tunnel supervisors must guide the form of Communication, Information, and Education (KIE) to the community to increase community participation in the Healthy Aisle program.

Partner-developed electronic health record tools to facilitate social risk-informed care planning.

Increased social risk data collection in health care settings presents new opportunities to apply this information to improve patient outcomes. Clinical decision support (CDS) tools can support these applications. We conducted a participatory engagement process to develop electronic health record (EHR)-based CDS tools to facilitate social risk-informed care plan adjustments in community health centers (CHCs). We identified potential care plan adaptations through systematic reviews of hypertension and diabetes clinical guidelines. The results were used to inform an engagement process in which CHC staff and patients provided feedback on potential adjustments identified in the guideline reviews and on tool form and functions that could help CHC teams implement these suggested adjustments for patients with social risks. Partners universally prioritized tools for social risk screening and documentation. Additional high-priority content included adjusting medication costs and changing follow-up plans based on reported social risks. Most content recommendations reflected partners' interests in encouraging provider-patient dialogue about care plan adaptations specific to patients' social needs. Partners recommended CDS tool functions such as alerts and shortcuts to facilitate and efficiently document social risk-informed care plan adjustments. CDS tools were designed to support CHC providers and staff to more consistently tailor care based on information about patients' social context and thereby enhance patients' ability to adhere to care plans. While such adjustments occur on an ad hoc basis in many care settings, these are among the first tools designed both to systematize and document these activities.

Community health centers response to the need of dementia care

Dementia prevalence among Indonesian older people is increasing. Community health centers (CHCs) as primary care providers have a responsibility to meet the need of their community. This study aims to measure the response of CHCs to the growing of dementia cases and to investigate factors associated with the knowledge of CHC staff on dementia symptoms in Special Region of Yogyakarta (DI Yogyakarta), Indonesia. This study used a cross-sectional design to obtain census data from 121 CHCs in DI Yogyakarta by interviewing 121 older person program managers of the CHCs via telephone between January and February 2021. Data on knowledge of 10 dementia symptoms, participation in dementia prevention and treatment with dementia, dementia/cognitive screening and coverage as well as factors associated with memory loss and change in mood and behavior were assessed. Data were analyzed using descriptive, bivariate, and multiple logistic regression. The knowledge of dementia symptoms among health workers was low (15%-37%). CHCs had not yet received training on dementia prevention and treatment (58%). Only a few of CHCs treated patient with dementia (36%). Dementia screening and coverage were also low. Engaged in dementia training were more likely to have higher knowledge of dementia symptoms, particularly memory loss and changes in mood and behavior. Dementia training and education are needed to increase knowledge among care providers which would eventually improve CHC response to dementia. Priority should also be in place to support dementia care management.

Factors Related to Family Health Behavior in Samosir District: A Mix-Methods Study

BACKGROUND: Non-communicable and communicable diseases remain a problem in Indonesia, where both are closely related to unhealthy behavior. Family health behavior affects the health status of the family and community.&#x0D; AIM: The study aims to examine the factors related to family health behavior in the Samosir district.&#x0D; METHODS: This study used a mixed-method approach with an explanatory sequential design. The respondents were 187 families who were selected through multi-stage random sampling. In-depth interviews were conducted with six informants: Samosir Health Department staff, Community Health Center staff, and religious or community leaders. The study was conducted in ten villages across three sub-districts. The instrument passed the validity and reliability tests and met triangulation. The Ethics Committee of the Faculty of Public Health, Universitas Indonesia has approved ethical clearance. Univariate and multivariate analysis with logistic regression (CI 95%) were used for quantitative data, while content analysis was used for qualitative data.&#x0D; RESULTS: In Samosir District, family health behavior (consisting of eating vegetables and fruits, not smoking at home, washing hands with soap and water, and using clean water) was low (12.8 %). Attitudes, income, and the availability and affordability of health care facilities all have a significant correlation with family health behavior, according to multivariate analysis. In content analysis, attitudes, economy, community characteristics, infrastructure, and access were discovered to be related to family health behavior.&#x0D; CONCLUSIONS: Health promotion strategies such as health education, community empowerment, and cross-sectoral collaboration must be thoroughly implemented to address the factors related to family health behavior because they can increase family health behavior through family empowerment.

Assessing the effectiveness of a diabetes group visit training for health center staff: a pilot study of five Midwestern community health centers

BackgroundDiabetes group visits are shared appointments that include diabetes education in a group setting and individual visits with a medical provider. An 18-month pilot study was designed to evaluate organizational capacity and staff preparedness in implementing and sustaining diabetes group visits.ResultsData were collected and analyzed from pre-post assessments and key informant interviews with community health center (CHC) staff (N = 26) from teams across five Midwestern states. Overall, participants demonstrated high baseline knowledge and awareness about diabetes group visit implementation. Changes in attitudes and practices did occur pertaining to familiarity with billing and increased awareness about potential barriers to diabetes group visit implementation. Key assets to diabetes group visit implementation were access to pre-designed resources and materials, a highly motivated team, and supportive leadership. Key obstacles were socioeconomic challenges experienced by patients, constraints on staff time dedicated to group visit implementation, and staff turnover.ConclusionsResults of the study provide a framework for implementation of diabetes group visit trainings for CHC staff. Future research is needed to assess the training program in a larger sample of CHCs.

IDF21-0521 Peer Support for Diabetes Management in the Shanghai Integration Model Developed Community Capacity to Combat COVID-19

Background: The Shanghai Integration Model linking primary, specialty, and hospital care includes peer support to help individuals carry out daily management of their diabetes. Initial results from 9 Community Health Centers (CHCs) in Shanghai documented improvements in glycated hemoglobin and other clinical and quality-of-life measures. Expansion to 12 additional communities enlisted neighborhood committees and Community Self Management Groups as well as CHCs to host and promote PS activities. Planned implementation from May 2019 to May 2020 was, however, interrupted by COVID. During the pandemic, peer support for diabetes management was reduced but maintained through WeChat groups and individual contacts while peer leaders also emerged as dependable community partners in responding to COVID-19. Aim: Characterize how the pandemic revealed a broader benefit of the Shanghai Integration Model and peer support in the capacity they provided CHCs and communities to respond to COVID-19. Method: Descriptive and qualitative study of program developments and observed benefits based on structured interviews with key informants among CHC staff, and community and district-level public health officers. Routine documentation of program activities. Results: As part of the proactive, highly coordinated responses of the Chinese government and citizens and the people’s shared sense of duty, peer supporters took an important role in their communities in Shanghai. In initial months of strict lockdowns, peer support pivoted from in-person activities to digital and telephone support. In 9 of 12 communities, peer leaders formed online WeChat groups that became valuable sources both for sustaining diabetes management and responding to COVID. These WeChat groups facilitated clinic-to-patient communication, community peer support, healthy lifestyles, and disseminated credible information about COVID as well as about obtaining medications and clinical services for diabetes. Respondents to structured interviews indicated that peer leaders assisted in their communities in various ways, such as distributing publicity materials, bringing groceries and supplies to older adults who could not leave their buildings, and distributing face masks. Illustrative comments included “Our diabetes team members are not just an audience during the entire epidemic prevention process…they actually give full play to their power as volunteers” and, “The cohesion, the coordination, the willingness to help, and the activity are important factors of a group leader. Those group leaders have put incredible efforts into the prevention and control of the COVID-19 epidemic.” A district level public health officer added, “These group leaders also help in society…they were basically active in all types of social welfare activities.” In addition to serving others, the collaborative relationships cultivated with other organizations created a basis for supporting each other when “everyone was under great pressure. Both leaders and colleagues cared for and encouraged each other, which was consistent with the emotional support content in the peer support program.” Discussion: Beyond direct benefits with diabetes, integration of care such as through the Shanghai Integration Model, peer support, and collaboration with community groups as well as CHCs enhance community capacity to address other health challenges, including even the unprecedented threats provided by COVID-19 in China and worldwide.