Promoting Health in Type 2 Diabetes: Nurse-Physician Collaboration in Primary Care

Abstract

The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study. Forty patients from a family practice clinic with type 2 diabetes were randomly assigned to control or experimental groups. The control group received standard care, whereas the experimental group received standard care plus home visits from a nurse, as well as consultation with an exercise specialist and/or nutritionist. Follow-up continued for 3 months. Clinical end points included standard measures of diabetes activity as well as quality-of-life indicators. Focus group interviews were used to explore patients' responses to the program. Although findings were not statistically significant, a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure. Quality of life measures also showed a trend toward small to moderate, but nonsignificant, improvements in physical functioning, bodily pain, vitality, social and global functioning, energy, impact of diabetes, and health distress. Focus group interviews indicated a very positive response from patients, who expressed feelings of empowerment. In this study, patients treated with nurse-physician collaboration demonstrated small, but nonsignificant, improvements in blood chemistry after only 3 months. Physical and social functioning, energy, and bodily pain also showed a small improvement. Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term.

Resources for and barriers to effective diabetes care management—experiences and perspectives of people with type 2 diabetes

“…It is of high importance to strengthen the responsibility and the autonomy of patients with diabetes in order to enhance diabetes self-management and diabetes-related quality of life. In addition, research has shown that nurse-led clinics can be an effective concept of care in primary and in partnership with GPs (General Practitioner) for people suffering from type 2 diabetes (Gabbay et al 2006;Taylor et al 2005;Wong and Chung 2006). Since only seven diabetics were interviewed the validity and reliability of the results are limited.…”

“…The workload as well as time pressure in primary care has increased considerably within the last years. Studies reveal that diabetes care management is in many cases uncoordinated, integrated health care concepts are absent and patients rarely receive a systematic consultation and education (Gabbay et al 2006;Möller et al 2004;Taylor et al 2005). Social, psychological and biographical aspects of the lives of diabetics are infrequently taken into consideration.…”

“…Forum für Gesundheitsziele Deutschland 2003; Möller et al 2004). However, due to the high amount of people suffering from diabetes in Germany and the high workloads of GPs (General Practitioner) and diabetes specialists, individual-centered counseling is hardly feasible (Gabbay et al 2006;Taylor et al 2005;Möller et al 2004). Based on these findings, nurse-led diabetes clinics within the primary care setting following a regular preventative home visit concept could improve the access to health care and patient-centred consultations.…”

“…Empowering people and supporting them in their needs is time-consuming. Due to high workloads and economic pressures GP's (General Practitioners) and specialists in private practices very often lack time to offer individual-centered, comprehensive discussions, consultations and instructions for the clients and their families (Gabbay et al 2006;Taylor et al 2005;Möller et al 2004). …”

Effectiveness of disease-management programs for improving diabetes care: a meta-analysis

“…In most trials, the length of intervention and the length of follow-up were similar, with only five trials reporting a few months' difference between the end of the intervention and hemoglobin A 1C assessment. 21,23,29,39,49 Most of the studies (29 trials) focused solely on type 2 diabetes, 9 included patients with either type 1 or 2 diabetes, and 3 trials focused on type 1 diabetes. The mean age of the participants was 57.6 years (SD 7.3); 46.0% were men.…”