The Role of the Nurse Practitioner in Addressing Healthcare Gaps and Integrated Care
- Publisher:
- International Diabetes Federation
- Publication Type:
- Conference Proceeding
- Citation:
- 2015
- Issue Date:
- 2015-11-29
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| Filename | Description | Size | |||
|---|---|---|---|---|---|
| IDF_WDC_2015_F.pdf | 547.06 kB |
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Background: The Nurse Practitioner (NP) is a new resource in the healthcare workforce within Australia. The NP role can enable early, prompt and specialised assessment and treatment in cases with diabetes. The role comprises skills in assessment, diagnostics, management of pharma-therapeutics, care coordination and research. Despite evidence to demonstrate safe and efficient models of care the role remains underutilized.
Aim: To describe the impact of the Nurse Practitioner role in areas of diabetes management.
Method: A critical review was undertaken over a three year period of outcomes of clinical audits performed by two Australian Nurse Practitioners working in differing settings; one metropolitan another rural regional.
Results: The NPs developed unique services to address healthcare gaps in diabetes in their respective areas due to identified service delivery gap and/or resources available. Alternatively the NPs worked in collaboration to provide the service when the issue was relevant to both areas eg a GLP-1 and insulin combination program for people with type 2 diabetes with significant insulin resistance. The GLP-1 service saw 70% of patients have a sustained reduction in HbA1c over 12 months >1% (28% ≥2%) [Graph1]. Pre-intervention mean HbA1c was 9.7% (range 7.7-12.9%), post mean HbA1c 7.7% (range 6.5-9.2%). Weight loss of up to 14kg was also seen in 70% of cases; weight maintenance or up to 1.5kg gain in others. Further, benefits were reflective to the complexity of each case including reduction in hypoglycaemia and progression in other morbidities (eg chronic cellulitis, chronic pain). The rural NP developed a systematic Diabetes in Pregnancy Model recognising shortages of endocrinologists and high adverse neonatal outcomes. The DIP service saw an increase in pre-pregnancy planning in pre-existing diabetes cases; a 24% decrease in combined adverse neonatal outcomes in all DIP cases [Graph 1]. A simple modelled economic analysis comparing the model to standard diabetes care, over a one year period identified annual care savings estimated at over $150,000AUS. Noting that it was an efficient and sustainable model within a severely resourced constrained rural context (Heath Economist Amanda Neil [Menzies Centre]). The Role of the Nurse Practitioner in Addressing Diabetes Healthcare Gaps and Integrated care The metropolitan NP developed a combined Clozapine/Diabetes clinic with the local Mental Healthcare team once non-attendances were found to be patients with mental health issues. The Clozapine service saw a 2-fold increase in screening tests performed; including screening for diabetes and metabolic markers in those with pre-existing diabetes. Further, a marked decrease in admissions to department of emergency medicine that included exacerbation of mental health in this patient population. Other activities by the NPs targeted issues such as:
• Gastroparesis to ensure prompt earlier diagnosis and treatment thus reducing glycaemic variability
• Obesity clinic for type 2's to encourage individualised multidisciplinary care with an overarching research project
• Collaboration with ambulance services to support hospital aversion by detecting vulnerable patients treated for hypoglycaemia but not admitted
• Care coordination for complicated patient cases with multiple morbidities .....
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