Audit of the effectiveness of nurse consultant led intermediate diabetes care services in England
Diabetes intermediate care clinics have been established to reduce costs compared to the tariff applied to hospital based clinics. However, little is known about the clinical effectiveness of these mainly nurse led clinics nor the degree of patient satisfaction in patients attending.
The aim of this audit was to assess clinical effectiveness and patient satisfaction in consultant nurse led intermediate care services.
Nine intermediate care services in England were included. Retrospective data on HbA1c, total cholesterol and blood pressure were collected from a total of 424 case notes (maximum of 52 per centre). Clinical effectiveness was assessed by comparison of data collection at referral and six months later using the Student's paired t-test. A Diabetes UK one-page questionnaire was sent to participants to assess the number of consultations, input, patient participation, and changes in practice post intervention. Individuals self-rated their ability to manage their diabetes before and after the intervention using a Likert scale.
Of the 424 patients, 87.5% (n=371) were type 2; mean age 59; 52% (107/205) were male. The mean number of appointments was 4.9, median 4 (IQR 4). The mean HbA1c reduction was 1.14% (9.53% [95% CI 9.33–9.73] to 8.39% [95% CI 8.22–8.56], p<0.0001); n=381. The mean total cholesterol reduction was 0.4mmol/L (4.6mmol/L [95% CI 4.46–4.74] to 4.2mmol/L [95% CI 4.09–4.34], p<0.0001); n=265. Reduction in blood pressure was not significant: mean systolic BP 137mmHg to 135mmHg, p=0.35, mean diastolic BP 79mmHg to 78mmHg, p=0.57 (n=269). Patient satisfaction questionnaires returned (n=123, 29%) showed 88% were ‘very satisfied’ concerns were met, 97% felt included in consultations and 80% made positive changes in their management of diabetes. A 3-point rise was seen in the Likert scale and average self-ratings doubled in perceived ability to self-manage post-intervention.
In conclusion, patients attending consultant nurse led services achieved significant improvements in HbA1c and cholesterol reduction, and experienced high patient satisfaction and increased confidence in their ability to self-manage their diabetes. Copyright © 2012 John Wiley & Sons.