Kahn Linda S, Fox Chester H, Carrington June, Desai Urmi, Bartlett Donald P, Lyle Heather, Kowalski Michelle
Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, ECMC Clinical Center, 462 Grider St., Buffalo, NY 14215, USA.
Chronic Illn. 2009 Dec;5(4):257-67. doi: 10.1177/1742395309350229.
Gold Choice, a partially capitated Medicaid managed care programme for individuals with a behavioural health diagnosis, implemented a telephonic nurse case management (TNCM) programme to improve diabetes self-management. We sought to identify issues faced by patients with co-morbid behavioural health diagnoses and diabetes as documented in the telephonic nurse case manager's progress notes. We also explored the role of the TNCM in addressing members' needs.
We undertook a qualitative analysis of 853 de-identified progress notes from 539 Gold Choice members and conducted a semi-structured interview with the TNCM.
Seven major themes emerged reflecting the nurse's perspectives on challenges faced by Gold Choice members and addressed by the TNCM: (1) Transience of the population. (2) Complex needs, involving not only medical and psychiatric conditions but also housing, transportation and survival. (3) Confusion regarding diabetes diagnosis. (4) Mistrust and suspicion. (5) Difficulties with medical care. (6) Need for diabetes self-management education/skills. (7) Marked appreciation that the TNCM would initiate contact and care about the patient.
Members with co-morbid behavioural health diagnoses and diabetes constitute a complex population with extensive needs. The TNCM's role extends beyond diabetes care and entails social support as well as navigation of the healthcare and social service systems.
“黄金选择”是一项针对有行为健康诊断的个人的部分按人头付费的医疗补助管理式医疗计划，该计划实施了电话护士病例管理（TNCM）项目以改善糖尿病自我管理。我们试图从电话护士病例经理的进展记录中找出患有合并行为健康诊断和糖尿病的患者所面临的问题。我们还探讨了TNCM在满足会员需求方面的作用。
我们对来自539名“黄金选择”会员的853份去识别化进展记录进行了定性分析，并对TNCM进行了半结构化访谈。
出现了七个主要主题，反映了护士对“黄金选择”会员所面临挑战以及TNCM所应对挑战的看法：（1）人群的流动性。（2）复杂需求，不仅涉及医疗和精神状况，还包括住房、交通和生存问题。（3）对糖尿病诊断的困惑。（4）不信任和怀疑。（5）医疗护理困难。（6）糖尿病自我管理教育/技能需求。（7）对TNCM会主动联系并关心患者表示高度赞赏。
患有合并行为健康诊断和糖尿病的会员构成了一个需求广泛的复杂群体。TNCM的作用不仅限于糖尿病护理，还包括社会支持以及医疗保健和社会服务系统的引导。
