Telephone nursing interventions can be very effective in providing diabetes education and improving diabetes-related outcomes. In the primary care setting, telephone care nurses could be able to regularly report problems to the patient’s health care provider and work closely with them to make changes in diabetes management plans. Nurse counseling can improve diabetes symptoms, glycemic control, self-management behaviors, and use of guideline-recommended diabetes services. Telephone nursing care is most effective if it is integrated as part of the role of a clinic-based registered nurse. This would increase the likelihood that the patient’s primary care provider would seriously consider integrating the advice of the clinic-based registered nurse. Primary care nurses could schedule calls to select patients and counsel them on exercise, diet, weight control, how to calculate body mass index, how to use fingerstick glucometers, and how to follow up on glucose results. Education is one of the most important tools for diabetes prevention, and support for the patient who is struggling to make the necessary changes in his/her lifestyle is critical. A telephone health program is one way to establish contact, encourage, educate, and monitor progress of a large group of patients.
A randomized controlled trial was performed to see whether a Pro-Active Call Center using trained nonmedical personnel who were supported by a diabetes nurse could effectively improve glycemic control in type 2 diabetes. A total of 591 individuals were divided into an usual care group and an intervention (call center) group. The personnel in the call center focused on patient education (lifestyle and medication adherence), metabolic management, and referrals. The frequency of the calls depended on the HbA1C level, and each call lasted 20 minutes. Satisfaction was assessed at baseline and at the end of the study using the Diabetes Satisfaction and Treatment Questionnaire. Patients who received diabetes counseling reported high levels of satisfaction and over 90% agreed that the “telecarer approach” was acceptable. Participants reported personalized service, increased well-being; and help with problem-solving. These results suggest that by focusing on the concerns of patients, individualized problem-solving, and continuity of care, health care providers can contribute to a successful patient-centered approach to diabetes management (Long, Gambling, Young et al, 2005). Care coordination enhanced by technology reduces hospital admissions, inpatient bed days of care, emergency department visits, and prescriptions, as well as results in higher patient and provider satisfaction. A chronically ill patient’s self-management goals or financial pressures may not be evident to their health care provider. By allowing nurses and patients to communicate without a formal office visit, telephone care can address disease management problems in a more timely way and allow communication when patients are in their homes or workplace.
Long, A., Gambling, T., Young, R., Taylor, J., Mason, J. (2005). Acceptability and Satisfaction with a Telecarer Approach to the Management of Type 2 Diabetes. Diabetes Care, 28(2), 283-289
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