Suuntima-palvelu segmentoinnin välineenä: Käytettävyys-, pätevyys- ja luotettavuustutkimus diabetesta sairastavilla potilailla perusterveydenhuollossa

Multimorbid and aging population requires a significant amount of health care services. Segmentation is used to relieve this burden on services and increasing costs. Segmentation means identifying groups of patients based on their similar needs in healthcare services. With targeted and needs-based services for groups, health care resources and professional support may be allocated for those groups with greatest need. With segmentation, the need for prioritization in health care is illustrated.

Suuntima (Navigator) is a patient-centred patient segmentation service, that considers patient’s ability and resources to manage in everyday life, and health status. The service is based on questions for customer and professional, and it forms four customer groups and care pathways (self-acting, community, co-operation and network groups). In this observational cross-sectional study, type 2 diabetic patients’ and professionals’ experiences using the first version of Suuntima (Suuntima 1.0) in a health center were explored. Patients’ distribution into the four groups, differences between the groups as well as validity and reliability of Suuntima in measuring the dimensions of patients’ coping in everyday life and health status were studied.

The data were collected between 10/2018 and 9/2019. We used questionnaires (user experiences, patients’ chronic conditions, diabetes and other medication, self- reported health), nurses’ focus group interviews, Suuntima database reports and diabetes care values (HbA1c, LDL, U-AlbKre, RR). We also used WHODAS 2.0 12 questions disability assessment, EQ5D5L health related quality of life measure and WBQ-12 well-being measure. All together 304 patients and 16 nurses participated the study.

Most patients ended up in the self-acting patients’ group. In addition to type 2 diabetes, hypertension, dyslipidaemia and joint ailment were the most frequent chronic conditions among all patients. Less ischaemic cardiac and pulmonary diseases, depression or anxiety and longterm pain as well as medication for these conditions were observed among self-acting patients. Their self- rated health, functional ability, quality of life and well-being were better compared to the other groups.

Suuntima proved to be well-functioning, suitable and applicable service at the appointment. Patients experienced, that Suuntima expanded their perspective in assessing their situation. Nurses reported, that discussion with patients deepened, and raising difficult issues became easier. The elderly benefited from nurses’ assistance in responding Suuntima. Clarification of some questions and concepts were suggested to standardize responding, and to finalize the content validity of Suuntima.

The results of Suuntima were compared with nurses’ pre-evaluation of patients’ group results (criterion validity), and the concordance was high with the self-acting group. In the other groups, using Suuntima changed the group result more evidently. Therefore, Suuntima may be beneficial in identifying patients ending up in community, co-operation and network groups.

Correlations between patients’ responses to Suuntima’s questions for customer and measures of disability, quality of life, well-being and self-rated health were statistically significant. Correlations between nurses’ responses to Suuntima’s questions for professional and the amount of patients’ chronic conditions and medication, as well as glycated haemoglobin, urine albumin-creatinine ratio and body mass index were positive and statistically significant. These results support the concurrent valid- ity of Suuntima.

Differences between age groups (less than 75 years and 75 years old and older) in responding to patient’s enablement, fulfilling care and patient’s health status related questions indicate discriminative ability and construct validity of Suuntima.

Internal consistency of Suuntima’s questions for customer and professional was acceptable. The retest reliability of Suuntima measured in approximately three weeks interval was poor.

In designing care pathways, the large proportion of self-acting patients among the study population should be noted. For example, offering digital services to support self-care may strengthen good care balance, and prevent additional illnesses and complications, as well as maintain patients’ good functional ability and quality of life. Suuntima strengthens patient-centredness at the appointments. Based on our results, Suuntima is suitable for segmenting patients at nurse’s appointment, and it is quite valid in measuring patients’ ability to function in everyday life and health status. More research is needed assessing the retest reliability of Suuntima.