Implementation of a diabetes nurse case management program in a primary care clinic: a process evaluation

Abstract

wolber t & ward d (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 122–134 Implementation of a diabetes nurse case management program in a primary care clinic: a process evaluationAims and objectives. The aim was to evaluate the design and implementation of a diabetes nurse case management program in a busy primary care practice. The process outcomes include: (1) demonstration of nurse competence in motivational interviewing techniques, collaborative use of medication protocols, and identification of achievable self‐management goals; (2) achieving a caseload of 15 to 20 patients; (3) evidence of weekly patient contacts; (4) demonstration of collaboration with primary care providers; (5) sustainability of the program through staff changes.Background. Program success or failure is determined not only by sound assumptions regarding how the interventions work but also by the strategy of implementation used and whether it was implemented properly. The utilisation of nurse case managers skilled in motivational interviewing techniques, independent use of medication protocols, and application of patient self‐management goals have improved patient diabetic outcomes in multiple settings. There is little literature on how to translate this evidence into busy primary care settings.Method. Four generalist nurses, trained in motivational interviewing, medication protocols and diabetes self‐management contacted patients by phone at one to two week intervals over a six‐month period. Quantitative evaluation was done through chart review and taped nurse encounters. Qualitative information was obtained using structured nurse interviews and participant observations at monthly nurse/provider meetings.Conclusions. Key attributes necessary for successful implementation include embracing principles of redesign at all levels, access to a central data base and electronic medical records for time efficiency, constant redistribution of tasks among team members, continuous constructive feedback to reach nurse competency, and a frank discussion of nursing scope of practice and autonomy.Relevance to clinical practice. This study identifies a promising model to implement nurse case management in primary care. Early outcome results favour dissemination across the organization. Adaptation of this program to other settings is possible using process evaluation planning.