The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes

Deborah Parker, Karen Clifton, Ridhwan Shams, Jacqui Young
JBI Library of Systematic Reviews 2012, 10 (38): 2514-2558

BACKGROUND: In Australia, diabetes was identified as a national health priority area in 1996; nevertheless the prevalence of type 2 diabetes has increased dramatically since then. Nurses have been working within Australian general practices for several decades but only in recent years has the role of the practice nurse in primary health care increased.

OBJECTIVES: This review aims to identify the effectiveness of nurse-led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes.

INCLUSION CRITERIA: Participants were adults (aged >18 years), with diabetes type 2 attending a general/family practice.Interventions of interest include nurse-led care in general practice in which the nurse is identified as taking a lead role in the care of patients with type 2 diabetes compared to general practitioner-led care.To evaluate the effectiveness of nurse-led diabetes care in general practice, this review sought randomised controlled trials as the study design of choice. Other research designs such as controlled clinical trials, interrupted time series and controlled before and after designs were also considered.The outcomes of interest were clinical outcomes including changes in systolic and diastolic blood pressure, body mass index, cholesterol levels, HbA1c (glycated haemoglobin) and fasting blood glucose.

SEARCH STRATEGY: A three step literature search was conducted for English language articles from January 1990 to December 2011.

METHODOLOGICAL QUALITY: Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.

DATA COLLECTION: Quantitative data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

DATA SYNTHESIS: Data from quantitative papers, where possible, were pooled in statistical meta-analysis using the Meta-Analysis of Statistics Assessment and Review Instrument. Additionally, RevMan 5 was used for presenting forest plots of the meta-analysis.

RESULTS: The electronic search yielded 804 potentially relevant papers of which 49 papers appeared to satisfy the criteria for inclusion and full texts of these papers were assessed against the inclusion criteria by two independent reviewers. From these papers, five were included in the review, four randomised control trials and one quasi-experimental study. These articles provided evidence that nurse-led care improves blood pressure and cholesterol levels for patients with type 2 diabetes attending a general practice.

CONCLUSIONS: There is some evidence to support the use of nurse-led care in general practice for patients with type 2 diabetes.

IMPLICATIONS FOR PRACTICE: If nurse-led care is implemented in the care of people with type 2 diabetes consideration needs to be given to the use of clinical algorithms, goal setting, individualised care plans, self management and follow up of lifestyle risk factors.

IMPLICATION FOR RESEARCH: More randomised controlled trials are required to assess the efficacy of nurse-led care including cost effectiveness.

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