Development of a Nurse-led Multidisciplinary Based Program to Improve Glycemic Control for People with Uncontrolled Diabetes Mellitus in a Community Hospital, Thailand
Keywords:
Glycemic Control, Multidisciplinary Approach, Nurse, Participatory Action Research, Uncontrolled Diabetes MellitusAbstract
A multidisciplinary approach is strategy for glycemic control management for diabetes care, yet the type of health workforce at each level of the healthcare system is unequal. This participatory action research was designed in three phases and undertaken in a community hospital in Thailand. Phase 1 aimed at discovering the causes of uncontrolled blood glucose by two focus group discussions with healthcare providers and people with diabetes. In Phase 2, focus group discussion with stakeholders were undertaken to learn from the Phase 1 data to build a program for improving glycemic control among uncontrolled diabetes. Phase 3 aimed at implementing and evaluating the effectiveness of the developed program using a quasi-experimental design. Data from focus group discussions were analyzed by content analysis while the data before and after intervention were analyzed by percentages, mean, standard deviation, and paired t-test.
Four categories related to causes of uncontrolled glycemia: poor hypoglycemic drug adherence, high energy dietary consumption, limitation on physical activity, and vigorous stress in life event. The improving glycemic control program developed in Phase 2 was the Nurse-led Multidisciplinary Based Program for People with Uncontrolled Diabetes. The Program goal was a decreased fasting blood glucose and an A1C of >8% and no hospital admission with either a hypoglycemic or hyperglycemic crisis. Program outcomes included significantly lower A1C compared with baseline levels (p<.01), and no hospital admissions. This Program provides an avenue for nurses to manage glycemic control in diabetes within a cooperative program in the community hospital.
References
World Health Organization. Global report on diabetes. Geneva: WHO press; 2016 [cited 2018 June 7]. Available from http://www.who.int/diabetes/global-report/en/.
Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice [internet]. 2014 [cited 2018 June 7]; 103:137-49. Available from http://www. diabetesresearchclinicalpractice.com/article/S01688227(13)00385-9/pdf.
Tiptaradol S, Aekplakorn W. Prevalence, awareness, treatment and control of coexistence of diabetes and hypertension in Thai population. Intern J of Hypertension [internet]. 2012 [cited 2018 June 7]; 2012 Article ID 386453. 7 pages Available from 10.1155/ 2012/386453.
Nanditha A, Ronald CW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, et al. Diabetes in Asia and the Pacific: Implications for the global epidemic. Diabetes Care [internet]. 2016 [cited 2018 June 7]; 39: 472–485. Available from 10.2337/dc15-1536
American Diabetes Association. Lifestyle management: Standards of medical care in diabetes-2017, Diabetes Care [internet]. 2017 [cited 2018 Dec 9]; 40(Suppl1): S1-S135. Available from https://professional.diabetes. org/files/media/dc_40_s1_final.pdf
Diabetes Association of Thailand, Department of Medical Service, National Health Security office. Clinical practice guideline for diabetes 2017. Bangkok: Rom-Yen LTD; 2017 [in Thai].
Department of Control, Ministry of Public Health. NCD Plus guideline 2019. Bangkok: Bangkok and Design Publisher; 2019. [cited 2019 Oct 10]. Available from http://www.thaincd.com/document/file/download/ paper-manual/NCDClinic_Plus_%E0%B8%9B%E0% B8%B52562.pdf [in Thai].
Health Data Center. The prevalence rate of patients with diabetes mellitus controlled by the glucose level. Fiscal year 2019 [cited 2019 Oct 10]. Available from https://hdcservice. moph.go.th/hdc/reports/report kpi.php? [in Thai].
Alzaheb RA, Altemani, AH. The prevalence and determinants of poor glycemic control among adults with type 2 diabetes mellitus in Saudi Arabia. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy [internet]. 2018 [cited 2019 Jan 20]; 11:15- 21. Available from 10.2147/DMSO.S156214.
Yigazu DM, Desse TA. Glycemic control and associated factors among type 2 diabetic patients at Shanan Gibe Hospital, Southwest Ethiopia. BMC Res Notes [internet]. 2017 [cited 2018 June 7]; Available from 10.1186/s13104017-2924-y.
Chester B, Stanely WG, Geetha T. Quick guide to type 2 diabetes self-management education: Creating an interdisciplinary diabetes management team. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy [internet]. 2018[cited 2019 Jan 5]; 11:641–645. Available from 10.2147/ DMSO.S178556.
Berard LD, Siemens R, Woo V. Clinical practice guidelines monitoring glycemic control Diabetes Canada Clinical Practice Guidelines Expert Committee. Can J Diabetes [internet]. 2018 [cited 2019 Jan 8]; 42: S47–S53 Available from 10.1016/J.JCJd.2017.10.007.
Minet L, Moller S, Vach W, Wagner LL, Henriksen JE. Mediating the effect of self-care management intervention in type 2 diabetes: A meta-analysis of 47 randomized controlled trialS. Patient Ed and Coun [internet]. 2010 [cited 2017 Jan 8]; 80(1): 29-41. Available from http://www.sciencedirect.com/science/article/pii/ S0738399109004492.
Ginzburg T, Hoffman R., Azuri JM. Improving diabetes control in the community: A nurse managed intervention model in a multidisciplinary clinic. Aust J of Ad Nurs [internet]. 2018 [cited 2019 Feb 12]; 35(2): 23-30. Available from http://www.ajan.com.au/Vol35/Issue2/3Ginzburg. pdf.
Tonboot S, Sooknak K, Chiangchaisakulthai K, Punnarunothai S. The effect of additional payment for health workers on case mix index in Thailand. J of Comm Dev Res (Humanity and Social Sciences) [internet]. 2018 [cited 2019 Oct 10]; 11(20): 70-80. Available from http://www.journal. nu.ac.th/JCDR/article/view/1978.
Pan American Health Organization. Innovative Care for Chronic Conditions: Organizing and delivering high quality care for chronic noncommunicable diseases in the Americas. Washington: PAHO; 2013. Available from https://www. paho.org/hq/dmdocuments/2013/PAHO-InnovateCare-2013-Eng.pdf.
Azami G, Soh KL, Sazlina SG, Salmiah S, Aazami S, Mozafari M, et al. Effect of a nurse-led diabetes selfmanagement education program on glycosylated hemoglobin among adults with type 2 diabetes. J of Diab Res [internet]. 2018 [cited 2019 Oct 10]; 2018 Article ID 4930157, 12 pages Available from 10.1155/ 2018/4930157.
Anaman P, Promdee A. Effectiveness of case management among patients with diabetes mellitus in primary care cluster at Mukdahan Hospital. Health Sci J, Suprasitthiprasong Nursing College [internet]. 2019 [cited 2019 Oct 10]; 3(2):37-55. Available from https://www. tci-thaijo.org/ index.php/bcnsp/article/view/195349 [in Thai].
Derm Khuntod N, Leewatthanapat PA. Study of the effects of diabetes education program on HbA1c for patient with type 2 diabetes. Vajira Nurs J [internet]. 2017 [cited 2019 Oct 10]; 19(1): 33-41. Available from https://www. tci-thaijo.org/index.php/vnj/article/view/1389 65/103231 [in Thai].
Supachaipanichpong P, Vatanasomboon P, Tansakul S, Chumchuen P. An education intervention for medication adherence in uncontrolled diabetes in Thailand. Pacific Rim Int J Nurs Res [internet]. 2018 [cited 2019 Oct 10]; 22(2): 144-155. Available from https://www.tci-thaijo. org/index.php/PRIJNR/article/view/84819.
Kim JH, Nam YJ, Kim WJ, Lee KA, Baek R, Park JN, et al. The effectiveness of multidisciplinary team-based education in the management of type 2 diabetes. J Korean Diab [internet]. 2018 [cited 2019 Oct 10]; 19(2): 119-133. Available from 10.4093/jkd.2018.19.2.119
Al-Dossary RN, Panagio K. The impact of diabetes nurse case management on hemoglobin A1c (HgbA1c) and self-efficacy of patients with type 2 diabetes: A systematic review. J of Clin Res & Governance [internet]. 2014 [cited 2019 Oct 10]; 3(1): 9-15. Available from 10.13183/ jcrg.v3i1.69.
Partiprajak S, Hanucharurnkul S, Piaseu N, Brooten D, Nityasuddhi D. Outcomes of an advanced practice nurse-led type-2 diabetes support group. Pacific Rim Int J Nurs Res [internet]. 2011 [cited 2019 Oct 10]; 15(4): 288-304. Available from https://www.tci-thaijo.org/index.php/ PRIJNR/article/view/6440.
Reutrakul Pratuangtham S, Jerawatana R. Effectiveness of diabetes self–management education in Thais with type 2 diabetes. Pacific Rim Int J Nurs Res [Internet]. 2018 [cited 2019 Oct 10]; 23(1):74-6. Available from: https:// www.tci-thaijo.org/index.php/PRIJNR/article/view/91968
Turale S, Fongkaew W. Editorial: Participatory action research: some strategies for publication of findings. Pacific Rim Int J Nurs Res [internet]. 2013[cited 2019 Oct 10]; 17(3): 301-303. Available from https://www.tci-thaijo. org/index.php/PRIJNR/article/view/12928/11607.
Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res [internet]. 2019[cited 2019 Oct 10]; Available from 10.1177/1049732318821692 journals.sagepub.com.
United States Agency for International Development (USAID). Performance monitoring and valuation tips: Conducting focus group interviews. Fact sheet; 1996. Available from http://www.pointk.org/resources/node/636.
Ovatakanont P. The outcome of diabetes care and factors associated with poor glycemic control among type 2 diabetic patients in Saimun Hospital. Srinagarind Med J [internet]. 2011[cited 2017 May 18]; 26(4):339-349. [in Thai]
Garcis-Perez LE, Alvarez M, Dilla T, Gil-Guillen V, Orozco-Beltra D. Adherence to therapies in patients with type 2 diabetes. Diab Ther [internet]. 2013[cited 2017 May 18]; 4: 175–194 Available from 10.1007/s13300 -013-0034-y
Leelayuwat N, Songsaengrit B, Kanpetta Y, Aneknan P, Tong- Un T. Effects of organic coconut flower syrup with and without insulin on glucose and insulin responses. Asia-Pacific J of Sci and Tech [internet]. 2018 [cited 2019 Oct 10]; 23(4) ID. APST-23-04-05. Available from https://www.tci-thaijo. org/index.php/APST/article/view/97471.
Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [internet]. 2018 [cited 2019 Oct 10]; 361: k2234 Available from 10.1136/bmj.k2234.
Jiang X, Fan X, Wu R, Geng F, Hu C, The effect of care intervention for obese patients with type II diabetes. Medicine [internet]. 2017 [cited 2019 Oct 10]; 96(42):e7524. Available from 10.1097/MD.0000000000007524.
Punarriwatana D. Factors associated with poor glycemic control among type 2 diabetic patients in Bang Phae hospital, Ratchaburi Province. Region 4-5 Med J [internet]. 2018 [cited 2019 Oct 12]; 37(4): 294–305. Available from https://www.tci-thaijo.org/index.php/reg45/article/ view/168377/121150.
Wharton S, Pedersen SD, Lau DCW, Sharma AM. Weight management in diabetes: Canada Clinical Practice Guidelines Expert Committee. Can J Diab [internet]. 2018 [cited 2019 Oct 8]; 42: S124–S129. Available 10.1016/j.jcjd.2017. 10.015.
Aikens JE. Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diab Care [internet]. 2012 [cited 2017 Jan 8]; 35:2472–2478. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3507577/.
Kalra S, Jena BN, Yaravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab [internet]. 2018 [cited 2019 Oct 12]; 22(5): 696–704. Available from 10.4103/ijem.IJEM_579_17.
Ward ME, Brún AD, Beirne D, Conway C, Cunningham U, English A, et al. Using co-design to develop a collective leadership intervention for healthcare teams to improve safety culture. Int. J. Environ. Res. Public Health [internet]. 2018 [cited 2019 Jan 8]; 15(6), 1182. Available from 10.3390/ijerph15061182.
Papoutsi C, Hargreaves D, Colligan G, Hagell A, Patel A, Campbell-Richards D, et al. Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): Protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model. BMJ Open [internet]. 2017 [cited 2019 Oct 8]; 7:e017363. Available from 10.1136/ bmjopen-2017-017363.
Warri G, Mutai J, Gikunju J. Medication adherence and factors associated with poor dherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan African Med J [internet]. 2018 [cited 2019 Jan 8]; Available from 10.11604/pamj.2018. 29.82. 12639.
Case Management Society of America. Standard of practice for case management [internet]. 2016 [cited 2019 Dec 6]; Available from https://www.miccsi.org/wp-content/ uploads/2017/03/CMSA-Standards-2016.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
