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

Chronic Illn. 2009 Dec;5(4):257-67. doi: 10.1177/1742395309350229.


Objectives: 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.

Discussion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Case Management / organization & administration*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / nursing*
  • Female
  • Health Services Needs and Demand
  • Healthcare Disparities
  • Humans
  • Male
  • Medicaid / organization & administration
  • Mental Disorders / complications
  • Mental Disorders / nursing*
  • Middle Aged
  • Nurse's Role
  • Primary Health Care
  • Program Evaluation
  • Qualitative Research
  • Remote Consultation*
  • Telephone*
  • United States