Telephonic nurse case management for patients with diabetes and mental illnesses: a qualitative perspective.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kahn
Linda S
LS
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. lskahn@buffalo.edu
Fox
Chester H
CH
Carrington
June
J
Desai
Urmi
U
Bartlett
Donald P
DP
Lyle
Heather
H
Kowalski
Michelle
M
D000328:Adult; D000368:Aged; D019090:Case Management / Q000458:organization & administration*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000451:nursing*; D005260:Female; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008484:Medicaid / Q000458:organization & administration; D001523:Mental Disorders / Q000150:complications / Q000451:nursing*; D008875:Middle Aged; D024802:Nurse's Role; D011320:Primary Health Care; D015397:Program Evaluation; D036301:Qualitative Research; D019114:Remote Consultation; D013689:Telephone; D014481:United States