From the Journals

Nurse-managed protocols benefit outpatients with chronic disease

Publish date: July 14, 2014
By
Sharon Worcester

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Nurses may be the answer

Given the shortage of primary care physicians in the United States, the finding by Dr. Shaw and associates that nurse-managed protocols have a positive effect on adult outpatients with chronic illness is welcome news, according to Dr. Sandeep Jauhar and Dr. David Battinelli.

However, the news is not surprising, they wrote in an editorial, noting that nurse-run, protocol-driven clinics are already being used successfully for managing chronic diseases in England and that studies show that such programs have the potential to prolong survival and decrease hospital admissions(Ann Intern Med 2014 July 14 [doi:10.7326/M14-1308]).

"Like it or not, outpatient medicine has become too complicated for physicians to handle by themselves. We need new models of primary care, and enlisting nurses will be central to this effort. Recognizing that nurse-managed protocols work for common outpatient diseases may be one step toward solving America’s primary care problem," they said.

Dr. Jauhar and Dr. Battinelli are with Hofstra University, Hempstead, N.Y. They reported having no disclosures.


 

FROM ANNALS OF INTERNAL MEDICINE

Nurse-managed protocols in the outpatient setting have consistently positive effects on adult patients with chronic disease, according to a meta-analysis of studies involving more than 23,000 patients.

In 18 studies in which a registered nurse or equivalent titrated medications for diabetes, hypertension, and hyperlipidemia by using a protocol, hemoglobin A1c levels decreased by a mean of 0.4%; systolic and diastolic blood pressure decreased by a mean of 3.68 mm Hg and 1.56 mm Hg, respectively; total cholesterol levels decreased by a mean of 0.24 mmol/L; and low-density lipoprotein cholesterol levels decreased by a mean of 0.31 mmol/L, compared with usual care, Ryan J. Shaw, Ph.D., of Duke University School of Nursing, Durham, N.C. and his colleagues reported online July 14 in Annals of Internal Medicine.

The findings suggest that a team approach involving nurse-managed protocols could be helpful for managing the increasing numbers of patients with chronic conditions who are expected to enter the health care system, the investigators said (Ann. Intern. Med. 2014 July 14 [doi:10.7326/M13-2567]).

"With changes in federal health policy, new models are needed to provide more accessible and effective chronic disease care. ... Our review shows that team approaches using nurse-managed protocols help improve health outcomes among patients with moderately severe diabetes, hypertension, and hyperlipidemia," they concluded, noting that "further research is needed to understand the effects of nurse-managed protocols in caring for complex or unstable patients."

This study was funded by the Department of Veterans Affairs.

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