title: Nursing consultations and control of diabetes in general practice: a retrospective observational study.
abstract: BACKGROUND
  Diabetes affects around 3.6 million people in the UK. Previous research found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received.
  
  
  OBJECTIVE
  To examine whether the proportion of consultations with patients with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c).
  
  
  METHODS
  A retrospective observational study using consultation records from 319 649 patients with diabetes from 471 UK general practices from 2002 to 2011.
  
  
  METHODS
  Hierarchical multilevel models to examine associations between proportion of consultations undertaken by nurses and attaining HbA1c targets over time, controlling for case-mix and practice level factors.
  
  
  RESULTS
  The proportion of consultations with nurses has increased by 20% since 2002 but patients with diabetes made fewer consultations per year in 2011 compared with 2002 (11.6 versus 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices in which nurses provide a higher proportion of consultations perform no differently to those where nurse input is lower (lowest versus highest nurse contact tertile odds ratio [OR] [confidence interval {95% CI}]: HbA1c ≤53 mmol/mol (7%) 2002, 1.04 [95% CI = 0.87 to 1.25] and 2011, 0.95 [95% CI = 0.87 to 1.03]; HbA1c ≤86 mmol/mol (10%) 2002, 0.97 [95% CI = 0.73 to 1.29] and 2011, 0.95 [95% CI = 0.86 to 1.04]).
  
  
  CONCLUSIONS
  Practices that primarily use GPs to deliver diabetes care could release significant resources with no adverse effect by switching their services towards nurse-led care.
authors.affiliation: National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London.
authors.forename: Trevor
authors.initials: T
authors.lastname: Murrells
authors.affiliation: NIHR CLAHRC Wessex, University of Southampton, Southampton.
authors.forename: Jane
authors.initials: J
authors.lastname: Ball
authors.affiliation: National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London.
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.affiliation: NIHR CLAHRC Wessex, University of Southampton, Southampton.
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000451:nursing / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000451:nursing / Q000628:therapy*; D064703:Family Nurse Practitioners; D058006:General Practice; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012017:Referral and Consultation; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes mellitus; general practice; health workforce; nurses; nursing staff; primary health care