Higher Diabetic Patient Satisfaction With Prescribing Nurses

Tara Haelle

October 06, 2015

Patients with type 2 diabetes have similar clinical outcomes regardless of whether they receive care from a nurse able to prescribe the same medications as doctors or a nurse without such prescribing capability, according to a new comparative case study published online September 21 in the Journal of Advanced Nursing.

Among more than 28,000 nurses in the United Kingdom who can prescribe drugs, more than 30% care for diabetic patients, primarily in general practice, note lead author Molly Courtenay, PhD, a professor in the College of Biomedical and Life Sciences at Cardiff University, Wales, and her coauthors.

"Given the key role that nurses now play in the care of patients with diabetes, findings from this study provide reassurance that these nurses (both prescribing and nonprescribing nurses) achieve positive health outcomes, and patients are very satisfied with the care they receive," Dr Courtenay told Medscape Medical News.

"Furthermore, patients of both types of nurse (prescribing and nonprescribing) reported high levels of satisfaction, particularly with regard to coping with chronic illness," she added.

One-Third of Diabetes Clinics in United Kingdom Primary Care Run by Nurses

As background, Dr Courtenay and colleagues explain that people with type 2 diabetes are increasingly managed in primary care in the United Kingdom, with referrals to specialist services only for unstable or complex patients. Primary-care teams provide routine care for about 75% of diabetic patients, and approximately 80% of general practices have a nurse with training in diabetes. Furthermore, one-third of diabetes clinics in primary care are run by practice nurses.

But little is known about the added value of nurse prescribers, compared with nurses without prescribing capability, the authors say.

They therefore compared 214 patients with type 2 diabetes who received care at one of 12 general practices in England: 131 patients were recruited by six nurses who could prescribe medicine and 83 were recruited by six nonprescribing nurses. All participants were adults taking oral hypoglycemic medication, insulin, or both and had been receiving care from that nurse for at least 1 year.

The patients of prescribing nurses had had diabetes for longer and received care from their nurse for longer than patients of nonprescribing nurses.

Over 6 months, the mean HbA1c decreased among all patients with no significant difference between patient groups. Similarly, average scores of self-care activities were similar between the groups at both 3-month and 6-month follow-up. Patients of prescribing nurses had a small decrease in body mass index (BMI) not seen in patients of nonprescribing nurses.

Although patients of prescribing nurses tended to test their blood glucose more often (3.4 days a week compared with 2.1 days among patients of nonprescribers; P = .001), this finding lost significance after researchers accounted for the fact that prescribing nurses asked their patients to check blood glucose more often than nonprescribing nurses did.

However, patients of prescribing nurses reported slightly more satisfaction and spent an average 7.7 minutes more time during each visit than patients of nonprescribing nurses did. Average satisfaction score among prescribing nurses' patients was 4.83, compared with 4.7 among those of nonprescribing nurses (P = .035).

The four areas with marked increased satisfaction included "the nurse knows which symptoms have been discussed before," "the treatment helps to control my diabetes," "the nurse provides advice that can actually be implemented," and "the nurse helps me to cope with diabetes."

"Since satisfied patients are more likely to cooperate with treatment, to maintain a continuing relationship with a practitioner and enjoy better health outcomes, the impact of nurse prescribers on satisfaction is important," Dr Courtenay told Medscape Medical News.

"However," note she and coauthors in the study, "the analysis did not suggest that this extra attention resulted in better HbA1c or self-management behaviors among the patients of nurse prescribers, and no differences were observed in use of other services between the patients of the two types of nurses."

Prescribing Nurses Cost More, but Contribute More

Other findings included the fact that nonprescribing nurses consulted more often with a doctor or colleague (27.6%) than prescribing nurses (10.3%). And nurses who could prescribe had slightly higher salaries than those who could not.

"Assuming practice overheads are similar for each nursing grade, hiring a more senior nurse with prescribing qualifications could thus add some £25,000 (US $38,000) per annum to the practice budget," write the authors.

"If primary-care practices are to realize the benefits of investing in prescribing nurses," Dr Courtenay said, "they must plan care carefully in order that the tasks in which these nurses are involved mean they are utilizing their prescribing skills and working to their full scope of practice and level of prescribing competence."

Available evidence suggests nurse prescribers are safe, prescribe clinically appropriate medicines, enable patients to access treatment faster, and result in patients satisfied with their care, she added.

"From a nurse's perspectives, prescribing makes better use of their skills and adds to job satisfaction," Dr Courtenay said. "However, a practice should consider hiring a prescriber only if they are going to adopt a role in the practice in which these skills will be utilized."

The research was funded by Sanofi and Pfizer. The authors report no relevant financial relationships.

J Adv Nurs. Published online September 21, 2015. Abstract

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