Physician–nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care

Abstract

Increasing demand to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care. The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care. One hundred fifty-seven patients with hypertension and diabetes mellitus were randomly assigned to their primary care physician and a nurse practitioner or their primary care physician alone. Costs for personnel directly involved in patient management, calculated from hourly rates and encounter time with patients, and pre- and post-study glycosylated hemoglobin (HbA(1c)), high-density lipoprotein cholesterol (HDL-c), satisfaction with care and health-related quality of life (HRQoL) were assessed. Although 1-year costs for personnel were higher in the team-treated group, participants experienced significant improvements in mean HbA(1c) ( - 0.7%, p = 0.02) and HDL-c ( + 2.6 mg dL( - 1), p = 0.02). Additionally, satisfaction with care improved significantly for team-treated subjects in several sub-scales whereas the mean change over time in HRQoL did not differ significantly between groups. This study demonstrates the value of a complementary team approach to chronic disease management in improving patient-derived and clinical outcomes at modest incremental costs.

Les pratiques infirmières avancées

“…Edwards et al (2003) 9 cliniques où les soins primaires sont assurés par les infirmières Grande qualité des soins (94% conformes aux recommandations existantes; 91% des patients très satisfaits et 94% indiquant l'intention de revenir). Litaker et al (2003) Résultats dans la gestion de maladies chroniques de patients traitées par des IPs ou des médecins (hypertension et diabète) Amélioration significative des patients concernant le contrôle de la pression artérielle et du diabète. Plus grande satisfaction des patients.…”

“…Plusieurs études ont établi que toute économie sur les salaires des infirmières (comparés à ceux des médecins) est contrebalancée en partie ou entièrement par différents facteurs tels que des consultations plus longues, une plus grande orientation des médecins vers d'autres docteurs ou des taux plus élevés dans la réitération de consultations, et parfois la prescription de davantage de tests. Si les services impliquent des tâches complémentaires par les infirmières en pratique avancée, alors le coût peut augmenter, comme indiqué par exemple dans l'évaluation d'un programme de gestion de maladies chroniques aux Etats-Unis (Litaker et al, 2003). Cependant, ces évaluations n'ont peut-être pas pris en compte des économies potentielles liées à l'empêchement de complications graves de ces affections chroniques.…”

“…Il faut aussi identifier les « facteurs de succès » qui contribuent à optimiser les résultats par rapport aux coûts dans la prestation des services, incluant le rôle joué par les infirmières en pratique avancée. De telles évaluations nécessitent des méthodes statistiques avancées, mais il est encourageant de constater que certaines des évaluations présentées dans cette section ont déjà progressé dans cette direction (e.g., Russell et al, 2009;Litaker et al, 2003;Mousquès et al, 2010).…”

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

“…39 As a result, justification is required to increase manpower in the department. 40 Some clinical studies have concluded that primary care teams improve outcomes at reasonable incremental costs [41][42][43] ; however, no economic evaluations on team-based solutions to decrease EDLOS have yet been reported. Given our era of limited health resources, 44 a rigorous determination of the cost-effectiveness of ED team-based solutions for LOS would help hospital administrators and decision makers decide whether implementation of a team-based approach to ED management is worth the expense.…”

Using Aggregate Data on Health Goals, Not Disease Diagnoses, to Develop and Implement a Healthy Aging Group Education Series

“…The primary healthcare system is in need of novel care models that leverage interprofessional team members to provide alternatives to physiciancentred care. In diabetes care for example, alternative care models [5][6][7][8] have been explored as approaches outside of traditional physician-led visits [9]. Group medical visits, self-management education and group education have become increasingly popular.…”