title: Out-of-office hours nurse-driven acute telephone counselling service in a large diabetes outpatient clinic: A mixed methods evaluation.
abstract: OBJECTIVE
  To map the usage of out-of-office hours acute telephone counselling (ATC) provided by diabetes specialist nurses (n=18) for diabetes patients to explore potentials for improvement.
  
  
  METHODS
  A mixed methods study involved mapping of ATC-usage during 6 months and a retrospective audit of frequent users.
  
  
  RESULTS
  Altogether, 3197 calls were registered that were related to 592 individual patients, corresponding to 10% of the population. Proportionally more users suffered from type 1 diabetes (p<0.001). ATC-users' mean HbA1c was 8.8% (73 mmol/mol) compared to 8.1% (65 mmol/mol) for all patients attending the clinic (p<0.001). Hyperglycaemia was the most frequent reason for calling. The use of ATC likely prevented 15 admissions. More than half of the calls came from general nurses based in the community (n=619) and general nurses and nursing assistants based in care homes (n=1018). The majority (75%) of patients called less than five times. However, 8% called 16 times or more accounting for 52% of all calls. A retrospective audit identified them as physically and/or psychologically fragile patients.
  
  
  CONCLUSIONS
  Hyperglycaemia was the most frequent reason for calling, and insulin dose adjustment the most frequent advice given.
  
  
  CONCLUSIONS
  Frequent users identified need additional support.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark; Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK. Electronic address: Mtdc@steno.dk.
authors.forename: Mette
authors.initials: M
authors.lastname: Due-Christensen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hilleroed, Denmark.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Kaldan
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark; Department of Endocrinology, Gentofte University Hospital, Gentofte, Denmark.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Almdal
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Glindorf
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Nielsen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark; Research Unit Women's and Children's Health, Rigshospitalet University Hospital, Copenhagen, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Zoffmann
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000554:Ambulatory Care Facilities; D003376:Counseling / Q000379:methods*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010043:Outcome and Process Assessment, Health Care; D019114:Remote Consultation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012648:Self Care; D013689:Telephone / Q000706:statistics & numerical data*
chemical_list: D007328:Insulin
keywords: Acute situations; Diabetes specialist nurse; Fragile patients; Multi-sectorial collaboration; Self-management; Telephone counselling