Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner‐led care for diabetes in pregnancy

Abstract

Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy. AbstractAim. To investigate maternal and neonatal outcomes following implementation of a nurse practitioner-led model of care for diabetes in pregnancy. Background. Diabetes in pregnancy increases the risk of adverse health outcomes in mothers and infants. The management of diabetes in pregnancy is crucial to reduce poor outcomes. Design. Uncontrolled before-after intervention study. Methods. International Classification of Diseases codes were used to identify pregnancies suspected of being complicated by diabetes. Demographic, health, diabetes and maternity data were extracted from hospital records. Adverse maternal and neonatal outcomes were compared pre- (2003)(2004)(2005)(2006) and postintervention (2010)(2011). Adjusted relative risks (aRR) were calculated using the glm command in Stata. Results. A total of 261 pregnancies were included: 112 pre-intervention and 149 managed under the nurse practitioner-led model. There were 37 women with preexisting diabetes (26 T1DM, 11 T2DM) and 195 with gestational diabetes. Referrals to dieticians and diabetes educators increased, while referrals to physicians decreased. There was no decrease in the risk of adverse maternal outcomes for all women with DIP or women with GDM. However, there was a 24% decrease in adverse neonatal outcomes overall and a 40% decrease among infants of women with gestational diabetes. Conclusion. The study demonstrated that nurse practitioner-led models of care for diabetes in pregnancy are feasible. The findings suggest that the model reduced adverse neonatal outcomes. By improving information provision, support and care coordination, the model is particularly valuable in rural areas, where access to medical specialists is often restricted.

How do nurse practitioners work in primary health care settings? A scoping review

“…Examples included diabetes management (Chang, Davis et al 2007, McCarrier, Ralston et al 2009, Conlon 2010, Stone, MacPherson et al 2010, Choi and Rush 2012, Jessee and Rutledge 2012, Murfet, Allen et al 2013 or encouraging healthy lifestyle changes (Speck, Hines-Martin et al 2007, Goessens, Visseren et al 2008, Perman 2008, Marion, Finnegan et al 2009, Whittemore, Melkus et al 2009, Whittemore, Melkus et al 2010, Courtney, Conard et al 2011, Stines, Perman et al 2011, Ter Bogt, Milder et al 2011, Vermunt, Milder et al 2011, Barte, ter Bogt et al 2012, Vermunt, Milder et al 2012, Jarl, Tolentino et al 2014. Although these programs did not ignore factors influencing patients' psychosocial health, it was clear that the focus was around treating or preventing exacerbation of existing conditions rather than addressing determinants of health.…”

“…In addition to the care populations identified, such as diabetes (Chang, Davis et al 2007, McCarrier, Ralston et al 2009, Conlon 2010, Stone, MacPherson et al 2010, Vermunt, Milder et al 2011, Choi and Rush 2012, Jessee and Rutledge 2012, Vermunt, Milder et al 2012, Murfet, Allen et al 2013 or the presence lifestyle risk factors for chronic disease (Speck, Hines-Martin et al 2007, Goessens, Visseren et al 2008, Stines, Perman et al 2011, Ter Bogt, Milder et al 2011, Barte, ter Bogt et al 2012, Allen, Dennison Himmelfarb et al 2014, Jarl, Tolentino et al 2014, nurse practitioners worked with populations who were considered vulnerable. This included ethnic groups identified as being at risk (Marion, Finnegan et al 2009, Choi and Rush 2012, Barrett , Salem et al 2015, Murphy, Coke et al 2015, individuals and groups from rural areas (Wright, Purdy et al 2007, Jessee and Rutledge 2012, Murfet, Allen et al 2013, Barrett , Salem et al 2015, Kozlowski, Lusk et al 2015, Tokuda, Lorenzo et al 2016, Tyler and Horner 2016, areas of socio-economic disadvantage (Speck, Hines-Martin et al 2007, Marion, Finnegan et al 2009, Lynam, Loock et al 2010, Stines, Perman et al 2011, Wong, Lynam et al 2012, Walker, Marshall et al 2013, Ri...…”

“…This included ethnic groups identified as being at risk (Marion, Finnegan et al 2009, Choi and Rush 2012, Barrett , Salem et al 2015, Murphy, Coke et al 2015, individuals and groups from rural areas (Wright, Purdy et al 2007, Jessee and Rutledge 2012, Murfet, Allen et al 2013, Barrett , Salem et al 2015, Kozlowski, Lusk et al 2015, Tokuda, Lorenzo et al 2016, Tyler and Horner 2016, areas of socio-economic disadvantage (Speck, Hines-Martin et al 2007, Marion, Finnegan et al 2009, Lynam, Loock et al 2010, Stines, Perman et al 2011, Wong, Lynam et al 2012, Walker, Marshall et al 2013, Ritten, Waldrop et al 2015, Berry, Williams et al 2016 or frail elderly (Wajnberg, Wang et al 2010, Prasad, Dunn et al 2014, Ritchie, Andersen et al 2016. In this way, nurse practitioners practiced to improve the health of hard to reach populations challenged with access and acceptability of traditional health care services.…”

“…Estimated cost savings were explicitly reported in three studies (Williams, Assassa et al 2005, Allcock 2009, Allen, Dennison Himmelfarb et al 2014) where other studies reported decreased use of services which would ultimately result in cost savings for the health care system. Examples of this include decreased use of emergency departments (Newcomb 2006, Owens, Eby et al 2012, Murphy, Siebert et al 2013, Roots and MacDonald 2014, reduced hospital admissions (Newcomb 2006, Allcock 2009, Godleski, Cervone et al 2012, Lowery, Hopp et al 2012, Murphy, Siebert et al 2013, Roots and MacDonald 2014, decreased length of stays (Godleski, Cervone et al 2012) and reduced visits to a general practitioner (Newcomb 2006, Allcock 2009, Enguidanos, Gibbs et al 2012, Murfet, Allen et al 2013, Prasad, Dunn et al 2014. Although the majority of studies reporting on use of services found promising results, two studies reported statistically insignificant results related to changes in the use of hospital and general practitioner services (Tung, Kaufmann et al 2012, Sawatzky, Christie et al 2013).…”

Impact of Advanced Access Scheduling on Patient Care Choices and Health Behaviours in a Nurse Practitioner-Led Clinic

“…A review of literature did not reveal evidence of nurse practitioner led clinics that are developed, governed and managed by nurse practitioners where the NP works within a team approach, but is the primary care provider at the clinic site. Although there are numerous nurse and nurse practitioner-led clinics in a variety of countries across the globe, they tend to offer specialized care and not comprehensive primary healthcare (Shiu et al 2011;Murfet et al 2013;Bentley et al 2014). In addition, health system funding in some countries, specifically the US and in some respects the UK, is not congruent with the NPLC model implemented in Canada (Auerbach et al 2013;Hoare et al 2011).…”