Eley Diann S, Patterson Elizabeth, Young Jacqui, Fahey Paul P, Del Mar Chris B, Hegney Desley G, Synnott Robyn L, Mahomed Rosemary, Baker Peter G, Scuffham Paul A
School of Medicine, The University of Queensland, Brisbane, Qld 4006, Australia.
Aust J Prim Health. 2013;19(2):150-8. doi: 10.1071/PY11164.
The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.
澳大利亚政府对医疗服务改革的承诺，已将全科医疗置于其慢性病管理议程的核心位置。对全科医生应对日益加重的慢性病负担能力的担忧，促使人们实施并测试能更好利用执业护士（PN）的新型护理模式。本文报告了一项混合方法研究，该研究嵌套于一项更大规模的研究之中，后者在三家全科诊所对一种由护士主导的慢性病管理新模式的可行性和可接受性进行了试验。年龄在18岁以上、患有2型糖尿病、高血压或稳定型缺血性心脏病的患者被随机分为由执业护士主导的护理组或由全科医生常规主导的护理组。主要结果是患者自我报告的生活质量，以及从患者和全科医生角度对该模式的可行性和可接受性的看法。在为期12个月的研究中，生活质量有所下降，但两组之间的趋势在统计学上并无差异。定性数据表明，由执业护士主导的模式对全科医生和患者来说是可接受且可行的。有可能扩大执业护士护理的范围，以主导对患者稳定慢性病的常规临床管理。所有全科医生都确定了该模式的显著优势，并在我们的研究结束后选择继续采用由执业护士主导的护理方式。
