title: Do primary health care nurses address cardiovascular risk in diabetes patients?
abstract: OBJECTIVE
  To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand.
  
  
  METHODS
  Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day.
  
  
  RESULTS
  The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001).
  
  
  CONCLUSIONS
  Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: b.daly@auckland.ac.nz.
authors.forename: Barbara
authors.initials: B
authors.lastname: Daly
authors.affiliation: General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kenealy
authors.affiliation: General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand.
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Sheridan
authors.affiliation: Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand.
authors.forename: Robert
authors.initials: R
authors.lastname: Scragg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000451:nursing; D002648:Child; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000451:nursing*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009726:Nurses / Q000592:standards*; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Blood pressure; Diabetes; Prevention; Primary health care nurses; Smoking