Primary care nurses: effects on secondary care referrals for diabetes

Abstract

BackgroundPrimary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with the introduction of primary care nurses, and whether these changes were related to the number of diabetes-related contacts in a general practice.MethodsHealthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that participated in the Netherlands Information Network of General Practice (LINH). Multilevel logistic and linear regression analyses were used to analyse the effect of the introduction of primary care nurses on referrals to internists, ophthalmologists and cardiologists and diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known T2DM patients.ResultsReferrals to internists for newly diagnosed T2DM patients decreased between 2004 and 2006 (OR:0.44; 95%CI:0.22-0.87) in all practices. For known T2DM patients no overall decrease in referrals to internists was found, but practices with a primary care nurse had a lower trend (OR:0.59). The number of diabetes-related contacts did not differ between practices with and without primary care nurses. Cardiologists' and ophthalmologists' referral rate did not change.ConclusionsThe introduction of primary care nurses seems to have led to a shift of care from internists to primary care for known diabetes patients, while the diabetes-related contact rate seem to have remained unchanged.

Discharge of breast cancer patients to primary care at the end of hospital follow-up: A cross-sectional survey

“…Another option may be the introduction of oncology nurses in primary care, 3 just as primary care nurses were introduced in Dutch general practice, partly to shift diabetes care from hospital to primary care. 35 Nevertheless, as the initiative to arrange follow-up visits and mammography appointments was mainly taken by patients in our study, the question arises whether follow-up should be patient-driven or primary care provider-driven. 36 Recently, Blaauwbroek et al 37 developed a (web-based) survivorship care plan for adult survivors of childhood cancer and their GPs.…”

Referral interventions from primary to specialist care: a systematic review of international evidence

“…System change interventions included the community provision of specialist services by GPs (n = 9), [108][109][110][111][112][113][114][115][116][117] outreach or community provision by specialists (wholescale provision of a hospital service within the community) (n = 10), [118][119][120][121][122][123][124][125][126][127] return of inappropriate referrals (n = 2), 128,129 the provision of additional primary care staff (n = 3), [130][131][132] the addition or removal of gatekeeping systems (requiring a primary care provider to give access to secondary care services) (n = 4), [133][134][135][136] changes to payment systems (n = 4), [137][138][139] and referral management centre or other major triage systems (n = 6). [140][141][142][143][144][145][146] The overall picture for interventions that aim to implement large system changes to impact on referral is mixed.…”

The interaction effect of health insurance reimbursement and health workforce on health care‐seeking behaviour in China

“…These findings are consistent with those of studies showing that the introduction of primary care workers would increase health care utilization and outpatient visits at PHCs among patients with chronic diseases. 16,30,31 In addition, studies in Sweden and Mexico have both indicated that government financial investment in PHCs can increase the number of visits to these facilities. 20,21 Second, the positive association between ARR at county hospitals and the probability of visiting those hospitals was stronger in areas with higher physician densities in the county hospitals.…”

“…14 Some studies found that introducing primary health care workers would increase health care utilization and outpatient visits at PHCs among patients with chronic diseases; however, these studies did not extend to inpatient health care or patients with different types of diseases. 15,16 Problematically, the growth in the PHC workforce is slow in China, particularly in light of rising health care demand: between 2000 and 2015, the number of registered (assistant) physicians per 1000 population in PHCs and county hospitals increased by about 30%, which was a lower rate of increase than that in high-level hospitals (about 55%). 11 This misallocation of the health care workforce might restrict the population from receiving inpatient services at PHCs and county hospitals.…”

“…The majority of studies in China and other developing countries have focused on individual health reform policies, such as reform of health insurance 4,5,[18][19][20][21] or investment in health workforce. 15,16 Several studies have assessed the effects of the health reform on health care access from a system-wide perspective; however, what is the relationship between specific health policies and health care-seeking behaviour is not examined. [22][23][24] Given the complexity of the health system, evaluation of a single policy has limitations: First, the overall impact of the health system reform on health care-seeking behaviour is not going to be clear if other potentially relevant policies are not considered.…”