title: [Nursing Workforce Characteristics and Control of Diabetes Mellitus in Primary Care: a Multilevel Analysis].
abstract: OBJECTIVE
  Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults.
  
  
  METHODS
  Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models.
  
  
  METHODS
  Poor DM control (figures equal or higher than 7% HbA1c).
  
  
  RESULTS
  The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]).
  
  
  CONCLUSIONS
  Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control.
authors.affiliation: Sección Departamental de Enfermería, Facultad de Medicina, Departamento de Medicina Preventiva, Universidad Autónoma de Madrid. IISPHM anaisabel.parro@uam.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Parro Moreno
authors.affiliation: Dirección Xeral de Innovación e Xestión da Saúde Pública. Xunta de Galicia.Instituto de Investigación Biomédica de Málaga.
authors.forename: M Isolina
authors.initials: MI
authors.lastname: Santiago Pérez
authors.affiliation: Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP).
authors.forename: Victor
authors.initials: V
authors.lastname: Abraira Santos
authors.affiliation: Gerencia de Atención Primaria Área Única. Madrid.
authors.forename: José Luis Aréjula Torres
authors.initials: JL
authors.lastname: Aréjula Torres
authors.affiliation: Gerencia de Atención Primaria Área Única. Madrid.
authors.forename: Antonio
authors.initials: A
authors.lastname: Díaz Holgado
authors.affiliation: Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria. Madrid.
authors.forename: Ana
authors.initials: A
authors.lastname: Gandarillas Grande
authors.affiliation: Departamento de Enfermería y Podología de la Universidad de Málaga.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Morales Asencio
authors.affiliation: Sección Departamental de Enfermería. Facultad de Medicina. Universidad Autónoma de Madrid.Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda (IISPHM).Investigación avanzada sobre Evaluación de la Ciencia y la Universidad (INAECU).
authors.forename: Pilar
authors.initials: P
authors.lastname: Serrano Gallardo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D054242:Emigrants and Immigrants; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009740:Nursing Staff / Q000592:standards / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin
keywords: Adults; Diabetes Mellitus; Multilevel analysis; Multivariate analysis; Nurses; Nursing staff; Primary Health Care; Spain