title: Shifting cardiovascular care to nurses results in structured chronic care.
abstract: OBJECTIVE
  To explore nurse involvement in cardiovascular risk management (CVRM) in primary care and how this involvement was associated with the degree of structured chronic illness care.
  
  
  METHODS
  A cross-sectional observational study in 7 European countries.
  
  
  METHODS
  Five aspects of nurse involvement in CVRM and 35 specific components of structured chronic illness care were documented in 202 primary care practices in Austria, Belgium, Germany, the Netherlands, Slovenia, Spain, and Switzerland. An overall measure for chronic care management, range 0 to 5, was constructed, derived from elements of the Chronic Care Model (CCM). Random coefficient regression modeling was used to explore associations.
  
  
  RESULTS
  A majority of practices involved nurses for organization of CVRM in administrative tasks (82.2 %), risk factor monitoring (78.5%) and patient education (57.1%). Fewer practices involved nurses in defining protocol and the organization for CVRM (45%) or diagnosis and treatment (34.6%). With an increasing number of tasks handled by nurses, overall median adoption of CCM increased from 2.7 (95% CI, 1.5-3.6) to 4.2 (95% CI, 3.8-4.1). When the number of nurse tasks increased by 1, the adoption of CCM increased by 0.13 (P <.05; 95% CI, 0.03-0.22). Some practices with low nurse involvement had high adoption of CCM, while variation of adoption of CCM across practices reduced substantially with an increasing level of nurse involvement.
  
  
  CONCLUSIONS
  Nurses were involved in the delivery of CVRM in varying degrees. Higher involvement of nurses was associated with higher degree of structured chronic illness care, with less variation.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands. E-mail: e.nouwens@iq.umcn.nl.
authors.forename: Elvira
authors.initials: E
authors.lastname: Nouwens
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Pieter
authors.initials: P
authors.lastname: van den Hombergh
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D002318:Cardiovascular Diseases / Q000451:nursing* / Q000517:prevention & control; D002908:Chronic Disease / Q000451:nursing*; D005060:Europe; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D015397:Program Evaluation; D012308:Risk Management