Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand

Abstract

AimsThe study aim was to re-examine current work practices and evaluate time trends in the cardiovascular management of people with diabetes consulted by primary healthcare nurses in New Zealand.Methods Primary healthcare nurses in the Auckland region were surveyed in 2006-2008 and 2016, with about onethird of practice, home care and specialist nurses randomly selected to participate. Nurses completed a self-administered questionnaire about demographic and workplace details, and a telephone interview about clinical care provided for people with diabetes during nursing consultations. Information was collected on a representative sample of people with diabetes consulted on one randomly selected work-day in the previous week.Results Of all people with diabetes consulted by nurses, practice nurses consulted significantly more in 2016 (83%) compared with 60% in 2006-2008, whereas specialist nurse consultations decreased from 23% to 8% (P = 0.01). In 2016, in people with diabetes, BMI was higher, and total cholesterol lower, yet the proportions of those receiving lifestyle advice (dietary and activity) remained unchanged from 2006-2008 levels. Smoking prevalence in people with diabetes was unchanged between the two surveys, although more people were asked if they wished to stop in 2016 compared with 2006-2008 (98% vs. 73%). In 2016, hours of nurses' diabetes education were associated with increased routine assessments of risk factors in people with diabetes and checking laboratory results.Conclusions Practice nurses are undertaking an increasing proportion of diabetes consultations. Although BMI in people with diabetes is increasing, the proportion of nurses offering lifestyle advice remains unchanged. Increasing diabetes education could strengthen the management of people with diabetes by community nurses. Diabet. Med. 36: 734-741 (2019) Correspondence to: Barbara M. Daly.

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

“…Quality scores, as assessed by the ICROMS tool, varied between studies. Three studies were scored at the minimum threshold for their study design [ 51 , 57 , 60 ], three studies scored 1–2 points above threshold [ 52 , 53 , 65 ], and eleven studies exceeded the minimum cut-off score by 3 or more points [ 50 , 54 – 56 , 58 , 59 , 61 – 64 , 66 ].…”

“…Study RNs received 9 h of training on the management of back pain RN provided intervention indepdendently. The intervention involved a 15–20-min educational session, including the booklet and a follow-up telephone call 1–3 days later Suburban primary care clinic in western Washington state, belonging to a staff model Health Maintenance Organization 24 Daly et al, 2000 [ 54 ] New Zealand To evaluate trends in foot examinations for people with diabetes by PNs, district nurses, and specialized nurses between 2006–2008 and 2016 and to determine whether the diabetes education of nurses is related to their management of foot diseases Quasi-experimental; two cross-sectional surveys 287 randomly selected PNs were surveyed in 2006–2008 and 336 PNs were surveyed in 2016. Nurses provided consulting information for 265 and 166 patients for 2006–2008 and 2016, respectively.…”

“…A variety of independent and interdependent RN interventions were examined across eligible studies. Most focused on some aspect of chronic disease prevention and management ( n = 7) related to diabetes, coronary heart disease, and obesity [ 50 , 52 , 54 , 60 , 61 , 64 , 65 ]. Other RN interventions included smoking cessation support [ 56 , 62 ], chlamydia screening, partner notification and treatment [ 51 , 63 ], back pain education and management [ 53 ], telephone consultation/triage service [ 57 ], assessment of psychological distress [ 66 ], consultations aimed at increasing patient physical activity levels [ 58 , 59 ], annual wellness visits [ 55 ], and laboratory monitoring [ 65 ].…”

“…Of the studies included, five examined a RN-led intervention compared to the same intervention delivered by other healthcare providers [ 56 , 60 , 62 – 64 ], six studies compared RN-led interventions to ‘usual care’, defined as either care that existed prior to the intervention that did not involve a RN ( n = 3) [ 50 , 53 , 59 ], or care associated with reduced or alternate levels of RN involvement ( n = 3) [ 51 , 52 , 58 ], and one study compared a collaborative intervention involving primary care RNs supported by two different types of healthcare providers (clinical pharmacy specialists [CPS] and physicians) [ 65 ], where RNs assessed patients independently and presented the patient to either a CPS or a physician if hypertension continued to be poorly controlled). Lastly, five studies examined the effectiveness of a primary care RN intervention using a quasi-experimental design as a means of evaluation (i.e., no comparison group) [ 54 , 55 , 57 , 61 , 66 ].…”

“…Nurse-led opportunistic testing for chlamydia in primary care is successful at increasing testing in both males and females. Daly et al, 2000 [ 54 ] New Zealand Rate of foot examinations and foot care education activities performed by PNs in 2006–2008 and in 2016 Significantly more nurses in 2016 than in 2006–2008 self-reported routinely examining patients’ feet (45% versus 31%) and giving foot-care education (28% versus 13%). District nurses were more likely to conduct foot examinations in 2016; however, PNs were significantly more likely than district nurses and specialist nurses to test sensation ( p = 0.0005).…”