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 patient outcomes, when tasks in the care for outpatients with stable type 2 diabetes are transferred from internist to nurse specialist and from outpatient clinic to general practice. Background. For the management of chronic diseases with a high prevalence and 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 nurse specialist model. Informed consent was obtained from patients with stable diabetes type 2 attending these practices. All patients received care according to the model chosen by their GP. Identified outcomes were: clinical status, health status, self-care behaviour, knowledge of diabetes, patient satisfaction, and consultation with care-providers. Results. In the control group (n=47) no patients were treated with oral hypoglycaemic agents (OHA) only. The control group was compared with an intervention subgroup (n=52) also without patients receiving OHA only. Clinical data were available for all patients. Patients without complete data from questionnaires had better mean concentration of HbA(1c) than patients with complete data (P=0.004). The traditional care model and the nurse specialist model achieved equal outcomes, while glycaemic control of patients in the nurse 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 beyond those traditionally regarded as their remit as well as new ones, is effective for the care of stable diabetic outpatients

Health life-styles, health concern and social position in Germany and the Netherlands.

Based on a telephone survey of 1352 adults in Germany and The Netherlands 3 health life-style dimensions were distinguished and labelled as: i) sobriety (not smoking, healthy food habits and abstinence from alcohol), ii) activity (participation in sports and exercise and low body mass index) and iii) free-living (alcohol consumption, unhealthy food habits and the (un)importance of physical appearance). Gender, age and level of education were much more important predictors of health life-styles than people's concern about their health. In both nations, women compared to men have a more sober, more active and less free-living life-style. In Germany, older persons are more sober, less active and less free-living. In The Netherlands, older persons were less active. A comparison of the results for Germany and The Netherlands suggests that the structural and cultural embeddedness of health life-styles is somewhat different in both nations

The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes

Department of Health Care Studies, University of Maastricht, P.O. Box 616, 6200 MD, Netherlands. [email protected] A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for patients with type 2 diabetes in a primary care setting. The shared care model resulted in an improved glycaemic control, additional consultations and other outcomes being equivalent to diabetes care before introduction, with the general practitioner as main care-provider. Assignment of care for patients with type 2 diabetes to nurse specialists seems to be justified

Effects of preventive home visits to elderly people living in the community: systematic review

Objective: To assess the effects of preventive home visits to elderly people living in the community. Design: Systematic review. Setting: 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register. Main outcome measures: Physical function, psychosocial function, falls, admissions to institutions, and mortality. Results: Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects. Conclusions: No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits

Continuïteit van medische zorg tussen verpleeghuisarts en huisarts.

In een descriptief onderzoek werd aan verpleeghuisartsen en huisartsen rondo

Variatie in samenwerkingsintensiteit tussen verpleeghuisarts en huisarts in

Een inventariserend onderzoek werd uitgevoerd naar de intensiteit van d