The Effect of Continuity of Care Training on The Knowledge of Multidisciplinary Team about Care for Elderly People with Diabetes Mellitus in Community Health Center

Citra Windani Mambang Sari; Rahadiani Ayu; Faiza Khalifatunnisa; Hartiah Haroen; Neti Juniarti

doi:10.24198/mkk.v9i1.67785

The Effect of Continuity of Care Training on The Knowledge of Multidisciplinary Team about Care for Elderly People with Diabetes Mellitus in Community Health Center

Citra Windani Mambang Sari, Rahadiani Ayu, Faiza Khalifatunnisa, Hartiah Haroen, Neti Juniarti

Abstract

Continuity of Care (CoC) is a healthcare approach that emphasizes continuity, coordination, and integration of care across time, providers, and levels of service. Older adults with diabetes mellitus (DM) require ongoing care because they have complex health needs, a high risk of complications, and long-term support needs for disease management. In primary healthcare settings, the implementation of CoC requires a good understanding among multidisciplinary healthcare workers. However, in Indonesia, healthcare workers’ understanding of CoC for older adults with DM remains limited. This study aimed to analyze the effect of Continuity of Care training on healthcare workers’ knowledge in caring for older adults with diabetes mellitus in Bandung City. This study used a pre-experimental one-group pretest-posttest design. The study was conducted in three community health centers in Bandung City that had nursing centers and high numbers of older adults with diabetes mellitus. The sample consisted of 33 healthcare workers, including physicians, nurses, pharmacists, and nutritionists. The training was conducted over two days in September 2025 using interactive lectures, case discussions, simulations, role-play, field practice, and evaluation. Knowledge data were collected using a questionnaire developed based on the training materials and analyzed using a paired t-test. The mean knowledge score increased from 13.82 ± 0.808 before training to 14.45 ± 0.617 after training. The paired t-test showed that the increase was statistically significant (p < 0.001). Continuity of Care training improved healthcare workers’ knowledge in caring for older adults with diabetes mellitus. Structured training may serve as an initial strategy to strengthen the capacity of healthcare workers in delivering collaborative and continuous care in primary healthcare settings.

Keywords: Continuity of care, diabetes mellitus, elderly, multidisciplinary team, training.

Full Text:

PDF

References

Albanese, M. P., et al. (2022). Integrating continuity of care and community engagement in health education: A scoping review. Frontiers in Public Health, 10, 950234. https://doi.org/10.3389/fpubh.2022.950234

Azadbakht M, Tanjani PT, Fadayevatan R, Foroughan M, Zanjari N. The Effect of a Peer Social Support Network Intervention on Self-management of the Elderly With Type 2 Diabetes. Journal of Client-Centered Nursing Care [Internet]. 2023;9(1):57–68. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85151831891&doi=10.32598%2fJCCNC.9.1.472.1&partnerID=40&md5=6c5d9647bfc179feb077ec249d0058a1

Barrio-Cortes J, Mateos-Carchenilla MP, Martínez-Cuevas M, Beca-Martínez MT, Herrera-Sancho E, López-Rodríguez MC, et al. Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups. BMC Endocr Disord. 2024 Dec 1;24(1).

Chan, K. S., Wang, H. H. X., Wong, S. Y. S., Cheung, R. T. F., Wong, M.-C., & Yeoh, E.-K. (2021). Effects of continuity of care on health outcomes among patients with diabetes and/or hypertension: A systematic review. BMC Primary Care, 22, 14. https://doi.org/10.1186/s12875-021-01493-x

Chao J, Zong M, Xu H, Yu Q, Jiang L, Li Y, et al. The long-term effect of community-based health management on the elderly with type 2 diabetes by the Markov modeling. Arch Gerontol Geriatr. 2014 Sep 1;59(2):353–9.

Chen, H.-M., & Su, B.-Y. (2022). Factors related to continuity of care and self-management of type 2 diabetes mellitus: A cross-sectional study in Taiwan. Healthcare, 10(10), 2088. https://doi.org/10.3390/healthcare10102088

Chen, H.-M., & Su, B.-Y. (2022). Factors related to the continuity of care and self-management of patients with type 2 diabetes mellitus: A cross-sectional study in Taiwan. Healthcare, 10(10), 2088. https://doi.org/10.3390/healthcare10102088

Elsayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 13. Older Adults: Standards of Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46:S216–29.

Gu X, Zhou C, Xie C. Effect of blood glucose management mode based on hospital- community linkage network on the elderly patients with type 2 diabetes | 医院-社区联动网络化血糖管理对社区老年 2 型糖尿病患者应用效果的研究. Chinese Journal of Practical Nursing. 2023;39(26):2007–13.

Kim W, Choy YS, Lee SA, Park EC. Implementation of the Chronic Disease Care System and its association with health care costs and continuity of care in Korean adults with type 2 diabetes mellitus. BMC Health Serv Res. 2018 Dec 22;18(1).

Li YJ, Zou ZH, Yi SY, Yu CY. Effects of Community Management Combined with Self-management on Treatment Compliance and Quality of Life in Elderly Patients with Type 2 Diabetes | 社区管理-自我管理模式对老年2型糖尿病患者服药依从性及生活质量的影响. Chinese General Practice. 2018;21(26):3217–22.

Li, Y.-C., Lee, T.-Y., & Wen, C.-P. (2019). Continuity of care for newly diagnosed diabetic patients: A population-based study. PLOS ONE, 14(8), e0221327. https://doi.org/10.1371/journal.pone.0221327

Liu J, Shi X, Guo B. Influence of Information-Based Continuous Care on Disease Control and Treatment Compliance of Elderly Diabetic Patients. Evidence-based Complementary and Alternative Medicine. 2022;2022.

Ma, J., et al. (2022). The relationship between continuity of care and health outcomes: A meta-analysis. International Journal of Integrated Care, 22(4), 7. https://doi.org/10.5334/ijic.6455

Markle-Reid M, Ploeg J, Fraser KD, Fisher KA, Bartholomew A, Griffith LE, et al. Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity. J Am Geriatr Soc. 2018 Feb 1;66(2):263–73.

Meiqari L, Al-Oudat T, Essink D, Scheele F, Wright P. How have researchers defined and used the concept of “continuity of care” for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework. Vol. 17, Health Research Policy and Systems. BioMed Central Ltd.; 2019.

Miklavcic JJ, Fraser KD, Ploeg J, Markle-Reid M, Fisher K, Gafni A, et al. Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: A pragmatic randomized controlled trial. BMC Geriatr. 2020 May 13;20(1).

Pitchalard K, Wimolphan P, Singkhorn O, Purkey E, Moonpanane K. Feasibility and Acceptability of the HOME Model to Promote Self-Management among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study. Health Equity [Internet]. 2022;6(1):629–37. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85138662629&doi=10.1089%2fheq.2021.0161&partnerID=40&md5=bbc12ea67cdf17f92a3f10ef802120d4

Ploeg J, Markle-Reid M, Valaitis R, Fisher K, Ganann R, Blais J, et al. The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP) for older adults with diabetes and multiple chronic conditions: study protocol for a randomized controlled trial. BMC Geriatr [Internet]. 2022;22(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85124175162&doi=10.1186%2fs12877-021-02651-7&partnerID=40&md5=7330bfbbae341c54706f9bc188a1913f

Putri, R., Handayani, S., & Nugraha, T. (2021). Implementation of continuity of care in community health services. Jurnal Kesehatan Masyarakat Nasional, 19(2), 201–210.

Rahmawati, N., Suryani, D., & Lestari, E. (2022). The effect of interprofessional training on the understanding of continuity of care in primary health services. Jurnal Keperawatan Indonesia, 25(3), 145–153. https://doi.org/10.7454/jki.v25i3.145

Rinda, A. C. (2023). Problems in continuity of care for patients with type 2 diabetes mellitus in Indonesia. Pharmacy Education Journal, 23(4). https://doi.org/10.46542/pej.v23i4.2287

Rochmah, T. N., et al. (2023). Implementation of interprofessional education in Indonesian community health centers: Challenges and strategies. Jurnal Keperawatan Indonesia, 26(2), 88–98. https://doi.org/10.7454/jki.v26i2.156

Saint-Pierre, C., Prieto, F., Herskovic, V., & Sepúlveda, M. (2019). Relationship between continuity of care in the multidisciplinary treatment of patients with diabetes and their clinical results. Applied Sciences, 9(2), 268. https://doi.org/10.3390/app9020268

Salisbury C, Sampson F, Ridd M, Montgomery AA. How should continuity of care in primary health care be assessed? British Journal of General Practice. 2009 Apr;59(561):276–82.

Sari, F., & Wulandari, H. (2023). Continuity of care as a strategy to improve the quality of community health center services. Jurnal Manajemen Kesehatan Indonesia, 11(1), 55–64.

Seah SJ, Harding SC, Wang J, Aw S, Lam J, Lim RBT. Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore. Science of Diabetes Self-Management and Care. 2022 Dec 1;48(6):505–21.

Situmorang, L. A. (2024). Continuity of care in midwifery practice: Implementation challenges in Indonesia. Prosiding Mitra Husada Forum Ilmiah, 4(2), 356–362.

Starfield, B., Shi, L., & Macinko, J. (2020). Contribution of primary care to health systems and health. Milbank Quarterly, 98(2), 233–259.

Valencia WM. The Elderly with Diabetes. In: The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues, Second Edition [Internet]. 2023. p. 1105–16. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85172150297&doi=10.1007%2f978-3-031-25519-9_66&partnerID=40&md5=eb7fa249866bf54e0d6a97e694668164

World Health Organization. (2021). Continuity and coordination of care: A practice brief to support implementation of the WHO framework on integrated people-centred health services. WHO Press.

World Health Organization. Innovative Care for Chronic Conditions : Building Blocks for Action. 2002;

DOI: https://doi.org/10.24198/mkk.v9i1.67785