{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:59:19Z","timestamp":1782842359874,"version":"3.54.5"},"reference-count":64,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients\u2019 characteristics is lacking.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses\u2019 appointments at a health center, the self-acting patient group\u2019s characteristics compared with other patient groups, and the concordance between the nurse\u2019s evaluation of the patient\u2019s group and the actual group assigned by Navigator (criterion validity).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with diabetes \u226518 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients\u2019 upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients\u2019 diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients\u2019 responses to Navigator\u2019s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients\u2019 distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Most patients (259\/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients\u2019 self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results.<\/jats:p>\n <\/jats:sec>\n \n International Registered Report Identifier (IRRID)<\/jats:title>\n RR2-10.2196\/20570<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/40560","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T03:19:01Z","timestamp":1687749541000},"page":"e40560","source":"Crossref","is-referenced-by-count":2,"title":["Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study"],"prefix":"10.2196","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8584-6862","authenticated-orcid":false,"given":"Riikka","family":"Riihimies","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8729-4851","authenticated-orcid":false,"given":"Elise","family":"Kosunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1518-4944","authenticated-orcid":false,"given":"Tuomas H","family":"Koskela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.2196\/30077"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30021-8"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6688"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19074173"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2018.09.005"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-020-01310-2"},{"issue":"4","key":"ref7","first-page":"3808","volume":"16","author":"Bradford, NK","year":"2016","journal-title":"Rural Remote Health"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1515\/sjph-2017-0020"},{"issue":"24","key":"ref9","first-page":"1","volume":"9","year":"2009","journal-title":"Ont Health Technol Assess Ser"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmab077"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.2196\/diabetes.6751"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.5873"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3992"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-051844"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1080\/07359680802126301"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1080\/1369118x.2015.1012532"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(20)30317-4"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1001\/journalofethics.2017.19.11.stas1-1711"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-019-1105-6"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01209-w"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-018-0584-9"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.2196\/20570"},{"key":"ref23","author":"Koivuniemi, K","year":"2011","journal-title":"Kohti asiakkuutta : ihmist\u00e4 arvostava terveydenhuolto"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-22"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-014-0185-6"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1643416"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.675523"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.12.2004"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-021-00639-3"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.4103\/aca.ACA_157_18"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.4324\/9781410615770"},{"key":"ref33","unstructured":"KatajapuuNPsychometric Properties of 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2)Jyv\u00e4skyl\u00e4 University20212023-08-05https:\/\/jyx.jyu.fi\/handle\/123456789\/74976"},{"key":"ref34","unstructured":"KoponenPBorodulinKLundqvistAS\u00e4\u00e4ksj\u00e4rviKKoskinenSHealth, functional capacity, and welfare in Finland - 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