title: Structured nursing follow-up: does it help in diabetes care?
abstract: BACKGROUND
  In 1995 Clalit Health Services introduced a structured follow-up schedule, by primary care nurses, of diabetic patients. This was supplementary care, given in addition to the family physician's follow-up care. This article aims to describe the performance of diabetes follow-up and diabetes control in patients with additional structured nursing follow-up care, compared to those patients followed only by their family physician.
  
  
  METHODS
  We randomly selected 2,024 type 2 diabetic subjects aged 40-76 years. For each calendar year, from 2005-2007, patients who were "under physician follow-up only" were compared to those who received additional structured nursing follow-up care.
  
  
  RESULTS
  Complete diabetes follow-up parameters including: HbA1c, LDL cholesterol, microalbumin, blood pressure measurements and fundus examination.
  
  
  RESULTS
  The average age of study participants was 60.7 years, 52% were females and 38% were from low socioeconomic status (SES). In 2005, 39.5% of the diabetic patients received structured nursing follow-up, and the comparable figures for 2006 and 2007 were 42.1% 49.6%, respectively. The intervention subjects tended to be older, from lower SES, suffered from more chronic diseases and visited their family physician more frequently than the control patients. Patients in the study group were more likely to perform a complete diabetes follow-up plan: 52.8% vs. 21.5% (2005; p < 0.001) 55.5% vs. 30.3% (2006; p < 0.001), 52.3% vs. 35.7% (2007; p < 0.001). LDL cholesterol levels were lower in the study group only in 2005: 103.7 vs. 110.0 p < 0.001.
  
  
  CONCLUSIONS
  Subjects with supplementary structured nursing follow-up care were more likely to perform complete diabetes follow-up protocol. Our results reinforce the importance of teamwork in diabetic care. Further study is required to identify strategies for channeling the use of the limited resources to the patients who stand to benefit the most.
authors.affiliation: Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel ; Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Shani
authors.affiliation: Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel ; Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sasson
authors.initials: S
authors.lastname: Nakar
authors.affiliation: Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel ; Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Lustman
authors.affiliation: Family Medicine Department Hadassah Medical School, The Hebrew University, Jerusalem, Israel.
authors.forename: Amnon
authors.initials: A
authors.lastname: Lahad
authors.affiliation: Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel ; Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
keywords: Diabetes mellitus; Family physicians; Nurses; Primary care