title: Nurse-led diabetes management in remote locations.
abstract: BACKGROUND
  Nurse-led diabetes management has been shown to be effective in urban and regional general practice. We sought to test the feasibility of providing a nurse-led annual cycle of diabetes care in a remote location and to explore the factors that patients indicated were important in diabetes self-management.
  
  
  METHODS
  We conducted a pilot study in 3 locations: 1 town and 2 small townships in remote Australia. A chronic disease nurse (CDN) visited each patient over the course of a year. We examined patient clinical outcomes and interview data. We estimated the cost per hour of the CDN's time, including travel time, per 1% drop in glycated hemoglobin (HbA1C).
  
  
  RESULTS
  A total of 21 patients participated in the pilot study. Clinical findings showed significant reductions in HbA1C levels after the nurse-led intervention. Patients reported that they trusted the nurse and thought her advice was pitched at their level. Patients were motivated through a process that included emotional response, change identity and acceptance. The estimated cost in CDN hours per 1% drop in HbA1C level was A$242.95 (Can$237.60).
  
  
  CONCLUSIONS
  Nurse-led diabetes care motivated patients to manage their diabetes and resulted in a significant improvement in diabetes management in this remote setting.
authors: Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia.
authors: Sue
authors: S
authors: Kirby
authors: Broken Hill University Department of Rural Health, University of Sydney, and Royal Flying Doctor Service, South Eastern Section, Broken Hill, New South Wales, Australia.
authors: Malcolm
authors: M
authors: Moore
authors: Royal Flying Doctor Service, South Eastern Section, Broken Hill, New South Wales, Australia.
authors: Trish
authors: T
authors: McCarron
authors: Centre for Rural and Remote Mental Health, University of Newcastle, Orange, New South Wales, Australia.
authors: David
authors: D
authors: Perkins
authors: Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia.
authors: David
authors: D
authors: Lyle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000451:nursing*; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services