This forum post is hidden because you have chosen to ignore diabetesMD. Show Details
This forum post is hidden because you have submitted an abuse report against it. Show Details
Arts EE, Landewe-Cleuren SA, Schaper NC, et al. The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. J Adv Nurs. 2012 Jun;68(6):1224-34. doi: 10.1111/j.1365-2648.2011.05797.x. Epub 2011 Oct 17. (Original)
RCT: Care by diabetes nurse specialists was similar to physician care for quality of life and cost-effectiveness in types 1 and 2 diabetes mellitus.
AIMS: To evaluate the cost-effectiveness of an intervention substituting physicians with nurse specialists.
BACKGROUND: Increasing populations of people with diabetes in most Western countries require creative solutions that give high-quality chronic care while controlling costs. Instigating nurse specialists as a substitute for physicians yields positive results in this area. Research about such interventions in a hospital-based setting is limited.
METHODS: This paper is a report of a study of a randomized, non-blinded clinical trial including people with diabetes mellitus types 1 and 2. In the intervention group nurse specialists were the central carers, providing care that conformed to a preset protocol. Patients were included between 2004 and 2007. Costs, quality of life and adverse events were measured, cost-effect ratios and incremental cost-effect ratios were calculated based on health-resource utilization rates, corresponding market prices and national tariffs from 2007.
RESULTS: Health related quality of life scores did not differ significantly between the control and the intervention group. In the intervention group, fewer patients were hospitalized and fewer side effects from drugs were reported compared to controls. Nurse specialists as central care givers generated a modest reduction in costs per quality adjusted life year gained compared to usual care.
CONCLUSION: Nurse specialists give diabetes care that is similar to care provided by physicians in terms of quality of life and economic value. Instigating a nurse specialist as central carer yields opportunities to generate cost savings. Developing interventions which also focus on prevention of complications is recommended when aiming for long-term organisational cost savings.
COMMENT: While an interesting contribution, this study does not add much to an already large body of data that suggest that in low risk populations advance practice nurses can deliver protocol-based care efficiently and effectively. In settings where there are such nurses such as In the United States, they are already seeing patients in primary care settings. In fact, the most common primary care practice in the US consists of a receptionist, an advance practice nurse or physician’s assistant and a physician. It is reassuring that they do a good job, but not particularly news.