Improved care of type 2 diabetes patients as a result of the introduction of a practice nurse: 2003–2007

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Primary care diabetes 08/2009; 3(3):165-71. DOI: 10.1016/j.pcd.2009.08.003
Source: PubMed


The main objective is to examine the effect of the introduction of a practice nurse (PN) on the quality of type 2 diabetes care.
Retrospective cohort study in 397 type 2 diabetes patients recruited from five general practices in the Netherlands. Measurements were performed in 2003, 2005 and 2007, to estimate the effects before (2003) and after the introduction of the PN (2005) as well as the changed diabetes guidelines (2007). Process measures indicated whether measurements of HbA(1c), systolic blood pressure, lipid profile, funduscopy, foot examination and annual check-ups were carried out. Outcome measures comprised actual levels of HbA(1c), systolic blood pressure, lipid levels and BMI.
All process measures - except performance of funduscopy - improved significantly. Mean HbA(1c) decreased from 6.8% to 6.5% (2003-2007: ns, 2005-2007: p<0.01), mean LDL-cholesterol from 3.2 to 2.7 mmol/L (p<0.0001) and mean total cholesterol/HDL-cholesterol ratio from 4.5 to 3.7 (p<0.0001). For systolic blood pressure, the number of patients reaching targets increased considerably in 2007. Analyses for both study populations at different time points as well as for patients present at all time points showed comparable results.
Delegating diabetes care to a PN leads to significant improvements in diabetes care. General practitioners should seriously consider close collaboration with PNs to delegate diabetes care tasks.

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Available from: Guy Rutten, May 08, 2015
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    • "In an observational study including academic general practices and their type 2 diabetes population identified through registers, Spigt et al. found optimal diabetes control to be associated with structural cooperation between the GPs and the nurses in the general practices [5]. A recent review and a before-and-after study found delegating diabetes care from GPs to general practice nurses to be associated with some improvements of the diabetes management, particularly the care process [6] [7]. Although much research has been devoted to exploring this issue from more or less real-life general practice perspectives in the Dutch setting, more knowledge is needed to assess whether patient outcomes may be associated with involvement of general practice nurses in type 2 diabetes care in other real-life practice settings and, indeed, if the Dutch findings are generalisable to other countries' healthcare systems. "
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