Primary Care Diabetes
Volume 3, Issue 3 , Pages 165-171, August 2009

Improved care of type 2 diabetes patients as a result of the introduction of a practice nurse: 2003–2007

  • Corine den Engelsen

      Affiliations

    • Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
    • Corresponding Author InformationCorresponding author at: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnr STR. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 756 8634; fax: +31 88 756 8099.
    • ,
  • Sabita S. Soedamah-Muthu

      Affiliations

    • Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
    • Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
    • ,
  • Nastasja J.A. Oosterheert

      Affiliations

    • General Group Practice Nieuwegein Zuid, The Netherlands
    • ,
  • Mireille J.P. Ballieux

      Affiliations

    • General Group Practice Nieuwegein Zuid, The Netherlands
    • ,
  • Guy E.H.M. Rutten

      Affiliations

    • Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

Received 4 December 2008; received in revised form 27 July 2009; accepted 2 August 2009. published online 02 September 2009.

Abstract 

Objective

The main objective is to examine the effect of the introduction of a practice nurse (PN) on the quality of type 2 diabetes care.

Methods

Retrospective cohort study in 397 type 2 diabetes patients recruited from five general practices in the Netherlands. Measurements were performed in 2003, 2005 and 2007, to estimate the effects before (2003) and after the introduction of the PN (2005) as well as the changed diabetes guidelines (2007). Process measures indicated whether measurements of HbA1c, systolic blood pressure, lipid profile, funduscopy, foot examination and annual check-ups were carried out. Outcome measures comprised actual levels of HbA1c, systolic blood pressure, lipid levels and BMI.

Results

All process measures – except performance of funduscopy – improved significantly. Mean HbA1c decreased from 6.8% to 6.5% (2003–2007: ns, 2005–2007: p<0.01), mean LDL-cholesterol from 3.2 to 2.7mmol/L (p<0.0001) and mean total cholesterol/HDL-cholesterol ratio from 4.5 to 3.7 (p<0.0001). For systolic blood pressure, the number of patients reaching targets increased considerably in 2007. Analyses for both study populations at different time points as well as for patients present at all time points showed comparable results.

Conclusions

Delegating diabetes care to a PN leads to significant improvements in diabetes care. General practitioners should seriously consider close collaboration with PNs to delegate diabetes care tasks.

Keywords: Diabetes mellitus, Type 2, Primary health care, Family practice, Practice nurse

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PII: S1751-9918(09)00082-5

doi:10.1016/j.pcd.2009.08.003

Primary Care Diabetes
Volume 3, Issue 3 , Pages 165-171, August 2009

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