Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 27, 2022
Date Accepted: Jun 26, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Segmenting diabetic patients with the Navigator service in primary care and description of the self-acting patients’ group: a cross-sectional study
ABSTRACT
Background:
The aim of patient segmentation is to recognize patients with similar health care needs. In addition to databased statistical segmentation methods, patients’ self-management skills and preferences should be considered in designing care pathways. The Finnish patient segmentation service Navigator segregates patients into four groups, that have separate care pathways. Self-acting patients’ group is one of the proposed. These patients are presumed to manage their everyday life and coordinate their health care. Digital services could support their self-care. By far, the knowledge on the self-acting patients’ characteristics is missing.
Objective:
We describe 1.) diabetic patients’ distribution into the four Navigator’s groups at nurses’ appointments at health center, 2.) the self-acting patients’ characteristics (diabetes-care, comorbidities, medication, disability, health-related quality of life, well-being, self-rated health, and digital skills), and 3.) the agreement between nurse’s evaluation of patient’s group and the actual group given by the Navigator (criterion validity).
Methods:
Primary care nurses used the Navigator with diabetic patients (n=304) at their annual health center visits. Patients responded to questionnaires considering their chronic conditions, medication, self-rated health, and health-related quality of life (EQ-5D-5L), well-being (WBQ-12), and disability (WHODAS 2.0). We collected patients’ diabetes-care values (HbA1c, U-AlbKre, LDL, RR, BMI, smoking status). We analyzed patients’ responses to Navigator’s question ‘Do you know how to use electronic services?’. We analyzed the data with IBM SPSS descriptive statistics and nonparametric tests and compared the self-acting patients’ results to the other patients’ results. Nurses’ evaluation of patients’ group was compared to the actual groups given by the Navigator to assess the criterion validity.
Results:
Most patients (n=259) ended up into the self-acting group. Their diabetes duration less than 10 years was significantly less compared to the other groups (p<0,05). Hypertension, hyperlipidemia, and joint ailment were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (p=0,001), depression/anxiety (p=0,029), asthma/COPD (p<0,001), and long-term pain (p<0,001), and less related medication. Self-acting patients had better ability to function (p<0,001), better health-related of quality of life (p<0,001), general well-being (p<0,001), and self-rated health (p<0,001). All patients considered their skills in using electronic services as good. Concordance between nurses’ evaluation of patients’ groups and the actual Navigator group was high (91,4%).
Conclusions:
The patients in self-acting group have several comorbidities. However, their ability to function, quality of life and well-being are not yet diminished compared to the other groups’ patients. The description of self-acting patients could help in designing integrated care pathways for them, and digital services could be involved in their care. Additionally, as the criterion validity result was high, assessing the situations the Navigator should be used in future is significant.
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