Nursing consultations and control of diabetes in general practice: retrospective observational study
Nursing consultations and control of diabetes in general practice: retrospective observational study
Background
Diabetes affects around 3.6 million UK people. Previous research using aggregated practice data found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received.
Aim
To examine whether the proportion of consultations with people with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c).
Design and Setting
A retrospective observational study using consultation records from 319,649 patients with diabetes in 471 UK General Practices from 2002-2011 to examine the associations between staffing inputs and control of diabetes.
Method
Hierarchical multilevel models to examine associations between the proportion of consultations undertaken by nurses and attainment of HbA1c targets in the practice population over time, controlling for case-mix and practice level factors.
Results
The proportion of consultations with nurses has increased by 20% since 2002 but people with diabetes made fewer consultations per year in 2011 compared to 2002 (11.6 vs 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices where nurses provide a higher proportion of consultations perform no differently to those where nurse input is less (lowest vs. highest nurse contact tertile OR [95%CI]: HbA1c ? 53 mmol/mol (7%) 2002 1.04 [0.87 – 1.25], 2011 0.95 [0.87 – 1.03]; HbA1c ? 86 mmol/mol (10%) 2002 0.97 [0.73 – 1.29], 2011 0.95 [0.86 – 1.04]).
?
Conclusion
Practices which primarily use GP’s to deliver diabetes care might release significant resources with no adverse effect by switching their services towards nurse-led care.
e642-e648
Murrells, Trevor
9a57589a-d893-415c-8c3d-8b25d052f42c
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Maben, Jill
3240b527-420c-498e-9f66-557b96561f40
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
1 October 2015
Murrells, Trevor
9a57589a-d893-415c-8c3d-8b25d052f42c
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Maben, Jill
3240b527-420c-498e-9f66-557b96561f40
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Murrells, Trevor, Ball, Jane, Maben, Jill, Ashworth, Mark and Griffiths, Peter
(2015)
Nursing consultations and control of diabetes in general practice: retrospective observational study.
British Journal of General Practice, 65 (639), .
(doi:10.3399/bjgp15X686881).
Abstract
Background
Diabetes affects around 3.6 million UK people. Previous research using aggregated practice data found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received.
Aim
To examine whether the proportion of consultations with people with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c).
Design and Setting
A retrospective observational study using consultation records from 319,649 patients with diabetes in 471 UK General Practices from 2002-2011 to examine the associations between staffing inputs and control of diabetes.
Method
Hierarchical multilevel models to examine associations between the proportion of consultations undertaken by nurses and attainment of HbA1c targets in the practice population over time, controlling for case-mix and practice level factors.
Results
The proportion of consultations with nurses has increased by 20% since 2002 but people with diabetes made fewer consultations per year in 2011 compared to 2002 (11.6 vs 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices where nurses provide a higher proportion of consultations perform no differently to those where nurse input is less (lowest vs. highest nurse contact tertile OR [95%CI]: HbA1c ? 53 mmol/mol (7%) 2002 1.04 [0.87 – 1.25], 2011 0.95 [0.87 – 1.03]; HbA1c ? 86 mmol/mol (10%) 2002 0.97 [0.73 – 1.29], 2011 0.95 [0.86 – 1.04]).
?
Conclusion
Practices which primarily use GP’s to deliver diabetes care might release significant resources with no adverse effect by switching their services towards nurse-led care.
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Nursing consultations and control of diabetes Final Revision v2.docx
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More information
Accepted/In Press date: 30 April 2015
Published date: 1 October 2015
Organisations:
Faculty of Health Sciences
Identifiers
Local EPrints ID: 379179
URI: http://eprints.soton.ac.uk/id/eprint/379179
ISSN: 0960-1643
PURE UUID: b5273919-87c3-40a0-bd6c-8ea61934ca60
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Date deposited: 21 Jul 2015 15:39
Last modified: 15 Mar 2024 03:51
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Contributors
Author:
Trevor Murrells
Author:
Jane Ball
Author:
Jill Maben
Author:
Mark Ashworth
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