title: Nurse-led clinics for patients with chronic diseases in hospital and transmural care organizations.
abstract: OBJECTIVE
  The objectives of this study were to elucidate the purpose, content, and organization of nurse-led clinics for patients with chronic diseases and to explore whether there are differences in the content and context of the nurse-led clinics and attention for the home situation between a transmural and a hospital setting.
  
  
  METHODS
  Transmural setting by which nurses work in both primary and secondary care and hospital setting where nurses are employed by a local hospital. Within the transmural setting, 4 nurse-led clinics were studied: heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis. Within the hospital setting, 3 nurse-led clinics were studied: heart failure, rheumatoid arthritis, and Parkinson disease.
  
  
  METHODS
  A multiple-case embedded design was used to investigate the content and context of the nurse-led clinics for patients with heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis in the transmural and hospital setting.
  
  
  METHODS
  One hundred twenty-one patient records, bimonthly telephone interviews with 218 patients, and face-to-face interviews with 7 nurses.
  
  
  RESULTS
  Nurses focus on disease itself, treatment, and the everyday life of the patient. In addition, nurses maintain contacts with colleagues and other disciplines both inside and outside the hospital. No influence of setting was found on the execution of nurse-led clinics.
  
  
  CONCLUSIONS
  Nurse-led clinics for chronically ill patients focus on all aspects of living with a chronic disease. The organizational context does not seem to contribute to the execution of the nurse-led clinics. Instead, this seems to be driven by patient needs, the definition of nursing and nursing competencies, and general developments in the nursing profession.
  
  
  CONCLUSIONS
  To improve nursing care for patients with chronic illnesses, changing the organizational context might not be useful.
authors.affiliation: Author Affiliations: Researcher, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, and District Nurse (Ms van der Kluit), Amsterdam Buitenveldert, Buurtzorg Nederland; and Senior Researcher (Dr Ros), Julius Center for Health Sciences and Primary Care, and Professor of Public Health (Dr Schrijvers), University Medical Center Utrecht, the Netherlands.
authors.forename: Maria Johanna
authors.initials: MJ
authors.lastname: van der Kluit
authors.forename: Wynand J G
authors.initials: WJ
authors.lastname: Ros
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D002908:Chronic Disease / Q000451:nursing*; D006801:Humans; D010044:Outpatient Clinics, Hospital; D057184:Practice Patterns, Nurses'