Department of Epidemiology and Public Health, University College Cork National University of Ireland, Cork, Ireland.
Department of General Practice, University College Cork, Cork, Ireland.
BMJ Open. 2017 Aug 11;7(8):e015049. doi: 10.1136/bmjopen-2016-015049.
International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement.
A cross-sectional survey of hospital and community-based DNS in Ireland.
Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave.
The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration.
Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.
国际证据表明，糖尿病专科护士（DNS）在支持糖尿病综合管理方面发挥着关键作用。我们研究了医院和社区 DNS 是否目前支持护理整合，检查与提供综合护理相关的服务的各个方面的区域差异，并确定服务提供的障碍和改进领域。
对爱尔兰的医院和社区 DNS 进行的横断面调查。
在 2015 年 9 月至 2016 年 4 月期间，对所有符合条件的爱尔兰 DNS（n=152）进行了一项包含 67 项项目的在线调查，包括关于其临床角色、糖尿病诊所、多学科工作以及服务提供的障碍和促进因素的封闭和开放式问题。排除退休、休产假或长期休假的 DNS。
应答率为 66.4%（n=101）：医院和社区 DNS 分别为 60.6%（n=74）和 89.3%（n=25）。大多数 DNS 的患者为稳定（81.8%）和复杂 2 型糖尿病（89.9%）。大多数人提供护士主导的诊所服务（81.1%）。几乎所有的 DNS 都与（91%）和为（95%）其他专业人员提供联络、支持和教育。然而，只有三分之一的人报告说，在医院和初级保健之间就他们的服务应该如何运作达成了当地协议。DNS 遇到的服务提供障碍包括专业人员（联合健康专业人员、内分泌学家和 DNS）的可用性不足、诊所空间不足、结构化教育和整合问题。
通过专科护士主导的方法提供综合糖尿病护理，需要明确解决更广泛的服务问题，包括在获取专科资源方面的区域差异，以及在不同环境之间正式确定多学科工作的协议和规范。
