School of Nursing
chronic care model, nurse practitioner, patient activation, self-care behaviors, type 2 diabetes
Despite all of the research that has demonstrated the importance of optimal control of diabetes, there are still many people who do not receive adequate care, education, and support in managing their diabetes (Barnard, Peyrot, & Holt, 2012; Rossi et al., 2015). This cross-sectional, descriptive, study examined the effects of the components of the Chronic Care Model on the outcomes of self-care behaviors and HbA1c levels for Type 2 diabetes patients cared for by nurse practitioners and physicians in the primary care setting. Specifically, this study examined the effects of self-management support, conceptualized as patient perceptions of patient activation, participation in decision-making, and practitioner facilitation of patient involvement in care. This study also examined the elements of the model together (community resources, self-management support, decision support, clinical information systems and delivery system design) for their combined and individual effect on patient self-care behaviors and HbA1c levels.
Participants of this study were diagnosed with type 2 diabetes, 18 years of age or older, and currently seeing a physician or nurse practitioner within a primary care setting for the care and management of their type 2 diabetes. Participants (N=82) completed a total of 6 questionnaires which included a demographics form, the Patient Activation Measure (PAM), the Facilitation of Patient Involvement Scale (FPI), the Perceived Involvement in Care Scale (PICS), and Patient Assessment of Care for Chronic Conditions (PACIC), and the Summary of Diabetes Self-Care Activities (SDSCA).
The PACIC was found to have significant associations with General Diet Score (p=.020), Specific Diet Score (p=.027), exercise (p=.032), and blood glucose testing (p=.046). The PAM was found to have significant associations with General Diet Score (p=.023) and foot care (p=.006). The FPI was found to have a significant association with blood glucose testing (p=.030). The PICS was found to have a significant association with blood glucose testing (p=.046).
The results were helpful to address some of the questions related to HbA1c and self-care behavior practices. Of notable importance, having no statistical significance in the results when comparing nurse practitioner patients and physician patients demonstrates that, in this particular study, there was no difference in the standards and variables that were measured comparing nurse practitioners and physicians. The patients who were cared for by both types of providers experienced similar outcomes with regard to self-care behaviors, HbA1c, levels of patient activation, participation in decision-making, and facilitation of patient involvement in care. Therefore, this is an important finding supporting the notion that care received by nurse practitioner patients and physician patients is not different.
Proie, C. D. (2017). An Examination of Factors Affecting Hemoglobin A1c Levels and Self-Care Behaviors among Type 2 Diabetic Patients in the Primary Care Setting (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/145