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Foppa L, Nemetz B, de Matos R, Schneiders J, Telo GH, Schaan BD. The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study. Diabetol Metab Syndr 2023; 15:172. [PMID: 37592361 PMCID: PMC10433589 DOI: 10.1186/s13098-023-01147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the effect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus. METHODS This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classification. The differences between glycated hemoglobin, adherence to self-care, and knowledge about initial and final diabetes were estimated to verify the effect of patient navigation by nurses, according to the tool applied in the first and last consultations. Interaction analyses between variables were also performed. Student's t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used. RESULTS The final sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45 ± 12 years, and diabetes duration of 23.6 ± 11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p < 0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p < 0.001). Adherence to self-care increased in 82 (53.9%) patients (p < 0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction effect (p = 0.005). However, we observed no interaction effect between glycemic control and the results from the questionnaire on adherence to self-care (p = 0.706). CONCLUSIONS Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil.
| | - Betina Nemetz
- Nurse School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil
| | - Rosimeri de Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
| | - Josiane Schneiders
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil
| | - Gabriela Heiden Telo
- Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6681, Partenon, Porto Alegre, RS, 90619-900,, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil
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Mabeza RM, Mao Y, Maynard K, Lee C, Benharash P, Yetasook A. Bariatric Surgery Outcomes in Geriatric Patients: A Contemporary, Nationwide Analysis. Surg Obes Relat Dis 2022; 18:1005-1011. [DOI: 10.1016/j.soard.2022.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 04/17/2022] [Indexed: 12/13/2022]
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Belyeu B, Chwastiak L, Russo J, Kiefer M, Mertens K, Chew L, Jackson SL. Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes in a Safety-Net Clinic. DIABETES EDUCATOR 2017; 43:621-630. [PMID: 29078730 DOI: 10.1177/0145721717739813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the study was to evaluate patient factors associated with nonengagement in a Diabetes Collaborative Care Team (DCCT) program in a safety-net clinic. Methods The first 18 months of a multidisciplinary care, team-based diabetes care management program in a safety-net primary care clinic were studied. Nonengagement was defined as fewer than 2 visits with a team member during the 18 months of the program. Patients who did not engage in the program were compared with those who did engage on demographics, comorbid medical and psychiatric diagnoses, and cardiovascular risk factors, using univariate and multivariable analyses. Results Of the 151 patients referred to the DCCT, 68 (45%) were nonengaged. In unadjusted analyses, patients who did not engage were more likely to be female and have higher baseline A1C values; they were less likely to have major depressive disorder, anxiety disorder, any depression diagnosis, and hyperlipidemia. Female gender and chronic pain were independently associated with nonengagement after multivariable adjustment. Conclusions The findings suggest that among patients with uncontrolled diabetes in an urban safety-net primary care clinic, there is a need to address barriers to engagement for female patients and to integrate chronic pain management strategies within multicondition collaborative care models.
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Affiliation(s)
- Brittaney Belyeu
- Kaiser Permanente West Los Angeles Medical Center, Department of Medicine, Los Angeles, California (Dr Belyeu)
| | - Lydia Chwastiak
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington (Dr Chwastiak, Dr Russo)
| | - Joan Russo
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington (Dr Chwastiak, Dr Russo)
| | - Meghan Kiefer
- the University of Washington School of Medicine, Department of Medicine, Seattle, Washington (Dr Kiefer, Ms Mertens, Dr Chew, Dr Jackson)
| | - Kathy Mertens
- the University of Washington School of Medicine, Department of Medicine, Seattle, Washington (Dr Kiefer, Ms Mertens, Dr Chew, Dr Jackson)
| | - Lisa Chew
- the University of Washington School of Medicine, Department of Medicine, Seattle, Washington (Dr Kiefer, Ms Mertens, Dr Chew, Dr Jackson)
| | - Sara L Jackson
- the University of Washington School of Medicine, Department of Medicine, Seattle, Washington (Dr Kiefer, Ms Mertens, Dr Chew, Dr Jackson)
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