Nurses are expected to play an increasingly important role in managing chronic diseases in general practice and primary health care more broadly.
A recent study investigated the feasibility and impact of a nurse-led collaborative care model of chronic disease management compared with standard GP-led care.
There were some encouraging findings: the GPs felt a lessening of the pressures on their time, and that the nurse-led care facilitated a greater sense of accountability among patients for self-management and supported patients in making necessary lifestyle changes.
The authors concluded that more, longer-term evaluations are needed. The study is profiled in the latest update from the Primary Health Care Research and Information Service (PHC RIS).
Investigating a nurse-led model of chronic disease management in Australian general practice
Petra Bywood writes:
It is estimated that by 2020, most of the global burden of disease may be attributed to chronic diseases. As health systems around the world struggle to cope with the growing demand for health care, the Australian government has put primary health care at the centre of its health reform policies. At the same time, strategies are needed to increase the capacity of the primary health care workforce to meet community needs.
One strategy is to employ practice nurses in general practice to perform many functions related to chronic disease management, including assessment, treatment management, self-management support and follow-up activities. The nurse-led chronic disease management role complements the general practitioner (GP)’s role, spreads the workload and frees up the GP’s time for patients with more serious conditions.
Nested within a large randomised controlled trial, researchers used semi-structured interviews and self-report questionnaires to assess the feasibility of a nurse-led collaborative care model of chronic disease management compared with standard GP-led care. Measures included practice staff and patients’ acceptance of the model and patients’ quality of life scores.
Six practice nurses, nine GPs and 285 patients from two general practices in Queensland and one in Victoria participated in the 2-year study. Patients with stable type 2 diabetes and/or cardiovascular disease were randomly assigned to nurse-led or standard GP-led care.
The nurse-led group received a General Practice Management Plan; and the practice nurse monitored patients, initiated visits, referred to the GP as required and provided patient education.
Although the authors reported that there were no significant differences between groups in patients’ health status or quality of life at 12 months follow-up, nurse-led patients appreciated the extra attention, greater opportunity to discuss their unmet needs, more explicit instructions and self-management support from the practice nurse.
Interpretation of findings is limited by the small number of participating practices and patients; and the potential for contamination across the groups. Disease progression was also a potential confounding factor; and it was unclear whether patients may have visited other practices during the study period. A longer follow-up is needed to better assess the effectiveness of the model as rapport between patients and practice nurses may develop over time.
Overall, the nurse-led model was feasible and generally acceptable to patients. While there was no significant improvement in nurse-led patients’ self-reported health status or quality of life, there was also no deterioration.
Therefore, this model has the potential to improve efficiency in general practice, without negatively impacting on patient outcomes. More research is needed to assess the cost-effectiveness of the model and the clinical equivalence between the nurse-led and GP-led models, using objective health outcomes.
• Petra Bywood is Research Manager, Primary Health Care Research & Information Service (PHC RIS)
Eley DS, Patterson E, Young J, Fahey PP, Del Mar CB, Hegney DG, Synnott RL, Mahoned R, Baker PG & Scuffham PA (2012). Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice. Australian Journal of Primary Health, doi: 10.1071/PY11164.
This article, which can be accessed at http://www.publish.csiro.au/paper/PY11164.htm features in the 24 May 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php
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