Providing Diabetes Self-Management Support in Rural Primary Care Clinics With Nurse Partners

Abstract

This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.

The changing role of the health care customer: review, synthesis and research agenda

“…First, considerable interest on the effects of the role of the customer have been evident in research in Self-Managed Care and Shared Decision-Making. In Self-Managed Care, changing the health care customer role to that of a self-manager has been shown to reduce hospital costs (Lorig et al, 2001), increase patient satisfaction (Lorig et al, 2008), improve health outcomes (Vetter-Smith et al, 2012), and lower overall mortality (Stock et al, 2010). Nonetheless, in the shared decision realm, Botti et al (2009) find that in situations of "tragic choice" where customers perceive causality for making decisions, there is more negative emotion than when the choice is made externally.…”

“…However, three types of effects have been identified: (1) improved customer perceptions of care and quality of life; (2) improved operational performance; and (3) improved health outcomes. Yet, too often the identified effects are limited to multiple case studies (e.g., Vetter-Smith et al, 2012) and studies with small sample sizes. This is particularly true when moving beyond the effects of customer perception towards effects on health outcomes.…”

“…[Longitudinal study of clinical outcomes, heart failure patients n=6618] • Self-management was shown to increase patient satisfaction for patients with long term diseases (Lorig et al, 2008). [Prospective longitudinal study, long term diseases n=443] • Nurse led self-management programs was shown to improve health outcomes for patients with diabetes (Vetter- Smith et al, 2012).…”

Self‐management support for chronic pain in primary care: a cross‐sectional study of patient experiences and nursing roles

“…Nevertheless, the provision of self‐management support for individuals with chronic pain faces multiple implementation challenges across primary care practices, is likely related to access to resources, including time and physical space and lack of knowledge and expertise (Vetter‐Smith et al . , Kennedy et al . ).…”

Comparative Effectiveness Research

“…Interventions designed to change health behaviors are often compared with health education interventions (Mallory & Hesson-McInnis, 2013). Unplanned and planned variations in intervention content or dose can yield CER information (Mowry & Hartman, 2011;Riesch et al, 2012;Vetter-Smith et al, 2012). Narrative reviews can provide information for comparing specific interventions (Dalky, 2012;Perez, Fleury, & Keller, 2010;Popejoy, Moylan, & Galambos, 2009;Rogers, Larkey, & Keller, 2009;Shearer, Fleury, Ward, & O'Brien, 2012).…”