Medication adherence, health-related quality of life, and hospital readmission outcomes of a diabetes transitional care intervention
DOI:
https://doi.org/10.57177/idn.v19.349Keywords:
diabetes, readmissions, transitional care, medication adherence, health-related quality of life.Abstract
Background: The time between hospital discharge and follow-up medical care is a time that often leaves people with diabetes without the support necessary to ensure medication adherence and assistance with determining when emergency care may be appropriate. The I-Care-4-Health Transition intervention was developed to reduce hospital readmissions.
Methods: A quasi-experimental intention-to-treat design was employed to evaluate a transitional care intervention in a Northeast Coast hospital in the United States of America, initiated during the initial hospital stay and continued for 6 months following hospitalization. The intervention adapted components of leading transitional care interventions. It was delivered to n = 86 people with diabetes by healthcare technicians serving in a navigational role with an advanced nurse practitioner-led team, which also included hospital nurses and physicians. Scripted talking points on red flag symptom instructions and medication adherence were delivered on scheduled telephone calls.
Results: Significant improvements were noted in medication adherence (t = 3.77, p < 0.001) and health-related quality of life (HRQOL) (t = 3.04, p = 0.003), with medication adherence predicting HRQOL at program completion (F = 8.37, p = 0.005). Medication side effects accounted for 42% of the variance in HRQOL, and suboptimal adherence was associated with hospital admissions (F = 4.5, p = 0.04). The readmission rate was 22% for the sample.
Conclusion: Team-based care can include technician-level navigators working under the supervision of advanced practice nurses to provide continuous, across-setting support through scheduled telephone calls, beginning during hospitalization and continuing after hospital discharge. The I-Care-4-Health Transitions project improved medication adherence and HRQOL in individuals with diabetes from low-income backgrounds and can ensure appropriate and timely emergency department use to prevent 30-day all-cause readmissions.
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