Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients

Aim of the study. Assessment of effects on quality of care, in terms of pat ient outcomes, when tasks in the care for outpatients with stable type 2 di abetes are transferred from internist to nurse specialist and from outpatie nt clinic to general practice. Background. For the management of chronic diseases with a high prevalence a nd requiring current monitoring, it is suggested that substitution of care may be an appropriate solution to safeguard high quality care. Design and methods. A 12-month nonequivalent control group design was used. General practitioners (GPs) referring diabetes patients to the University Hospital Maastricht were asked to choose for the traditional model or the n urse specialist model. Informed consent was obtained from patients with sta ble diabetes type 2 attending these practices. All patients received care a ccording to the model chosen by their GP. Identified outcomes were: clinica l status, health status, self-care behaviour, knowledge of diabetes, patien t satisfaction, and consultation with care-providers. Results. In the control group (n=47) no patients were treated with oral hyp oglycaemic agents (OHA) only. The control group was compared with an interv ention subgroup (n=52) also without patients receiving OHA only. Clinical d ata were available for all patients. Patients without complete data from qu estionnaires had better mean concentration of HbA(1c) than patients with co mplete data (P=0.004). The traditional care model and the nurse specialist model achieved equal outcomes, while glycaemic control of patients in the n urse specialist model improved (from 8.6% to 8.3%) but deteriorated in the traditional model (from 8.6% lo to 8.8%; P-value between groups = 0001). Conclusions. The model with nurse specialists taking on roles and tasks bey ond those traditionally regarded as their remit as well as new ones, is eff ective for the care of stable diabetic outpatients.