Improved care of type 2 diabetes patients as a result of the introduction of a practice nurse: 2003-2007.
OBJECTIVE
The main objective is to examine the effect of the introduction of a practice nurse (PN) on the quality of type 2 diabetes care.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
den Engelsen
Corine
C
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. c.denengelsen-2@umcutrecht.nl
Soedamah-Muthu
Sabita S
SS
Oosterheert
Nastasja J A
NJ
Ballieux
Mireille J P
MJ
Rutten
Guy E H M
GE
D000284:Administration, Oral; D057179:Advanced Practice Nursing; D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000451:nursing*; D003927:Diet, Diabetic; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009736:Nursing Process; D012189:Retrospective Studies; D016896:Treatment Outcome
D002784:Cholesterol; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin