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.
Highlights
Primary care nurses play an important role in diabetes care, and were introduced in general practitioners (GPs)-practice partly to shift care from hospital to primary care
To answer the research questions we analysed whether the referral rate to internists, ophthalmologists, cardiologists and mental healthcare changed from 2004 to 2006, and whether or not this was different for general practices with and without primary care nurses
The referral rate to internists for newly diagnosed T2DM patients decreased in general practices both with and without a primary care nurse between 2004 and 2006, and the trend in referral rate to internists between 2004 and 2006 for known T2DM patients was lower in general practices with primary care nurses than in general practices without primary care nurses
Summary
Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. Primary care nurses have established their position in general practice in several countries in the last decades. They play an increasingly important role in the care of type 2 diabetes (T2DM) patients, and in health promotion and routine management of these patients[1,2,3]. Three examples of countries where new contracts and regulation for primary care nurses were implemented are the United Kingdom, Australia and the Netherlands. In the United Kingdom, the introduction in 2004 of the Quality and Outcomes Framework (QOF) within the New General Medical Services Contract has resulted in an extension of the activities of primary care nurses in the management of chronic illnesses such as asthma and diabetes[5,9]
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