Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care.
OBJECTIVE
To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients.


METHODS
Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group).


RESULTS
After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p≤5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p≤5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group.


CONCLUSIONS
This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities.
Mousquès
Julien
J
Institute for Research and Information in Health Economics (IRDES), Paris, France. mousques@irdes.fr
Bourgueil
Yann
Y
Le Fur
Philippe
P
Yilmaz
Engin
E
D003299:Cooperative Behavior; D003363:Cost Control; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D005602:France; D058005:General Practitioners; D017048:Health Care Costs; D006801:Humans; D009726:Nurses; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D016896:Treatment Outcome