Department of Integrated Care, Care and Public Health Research Institute, Maastricht University Medical Centre/CAPHRI Maastricht, the Netherlands.
Br J Gen Pract. 2010 Jan;60(570):40-6. doi: 10.3399/bjgp10X482095.
A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses.
To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up.
Prospective pragmatic randomised trial.
Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated.
A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire.
A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided).
Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care.
心血管疾病预防的很大一部分是在初级保健中进行的。应特别注意评估心血管危险因素。根据荷兰心血管风险管理指南，全科医生的心血管风险管理工作量很大，可以与高级执业护士分担。
在 1 年的随访后，调查执业护士替代全科医生进行心血管风险管理的临床效果。
前瞻性实用随机试验。
荷兰南部的基层医疗。有 6 个中心（25 名全科医生，6 名护士）参与。
共有 1626 名患有心血管疾病高危的潜在合格患者于 2006 年被随机分配到执业护士组（n = 808）或全科医生组（n = 818）。共有 701 名患者参加了试验。该试验采用了荷兰心血管风险管理指南作为方案，使用标准化的风险评估技术。测量了 1 年后以下风险因素的变化：血脂、收缩压和体重指数。此外，全科医生组的患者还接受了一份简短的问卷。
与全科医生组相比，执业护士组的平均风险因素水平下降幅度更大。在控制了混杂因素后，只有执业护士组总胆固醇的较大降幅具有统计学意义（P = 0.01，双侧）。
高级执业护士在管理风险因素方面取得的结果与全科医生相当，甚至更好。这项研究的结果支持在荷兰初级保健中引入执业护士参与心血管风险管理。
