Nurse-led care in managing adults with type 1 or 2 diabetes in general practice

Danielle Holloway

doi:10.25907/00984

The purpose of this PhD thesis is to evaluate Australian nurse-led care and management of patients with type 1 or 2 diabetes in general practice settings. The care of patients with type 1 or 2 diabetes is complex, and most of these patients are receiving care through general practices in Australia. Diabetes is one of the most significant global concerns facing our healthcare system today. The World Health Organisation have classified it as a pandemic, evident in Australia with over 280 people being diagnosed each day. A mixed methods study with a sequential explanatory design was used for this PhD project. At the completion of the systematic literature review, Study 1 commenced with the quantitative phase, collecting retrospective cross-sectional data on 766 patients in seven general practices in urban and regional sites over 12 months. To compare nurse-led and doctor-led care, examining differences in demographic variables and clinical characteristics, particularly emphasizing the difference in HbA1c results. Study 2 Phase 1 involved an anonymous QualtricsXM online survey of 117 nurses and 12 doctors, that was used to inform subsequent nurse interviews. Survey questions were organised into four themes this included: experience and training, chronic disease management (CDM) care planning, the diabetes cycle of care, and nurse beliefs and satisfaction. Study 2, Phase 2 was a qualitative study involving interviews, recruiting 15 nurses from metropolitan, regional, and rural areas, who participated in the QualtricsXM survey, this phase provided depth and exploration. To complement the findings in the quantitative phase. Study 3 used both quantitative and qualitative question and was. conducted using an anonymous QualtricsXM survey of 52 adult patients with type 1 or 2 diabetes. Questions were developed according to themes that impacted care: appointment availability, time spent completing the care plan, HbA1c testing, and patient satisfaction. The findings of study 1 showed that nurse-led care effectively managed older patients with more comorbidities, achieving HbA1c and glucose control outcomes similar to those of doctorled care, but when comparing first and last HbA1c in the nurse-led only group there was a significant difference in the HbA1c results. The results of study 2 found that nurses in general practice are more likely to complete the annual diabetes cycle of care than doctors. Both nurses and doctors agree that better patient outcomes could result from nurse-led care planning. Though the current Medicare funding framework limits nurses' ability to undertake this care planning independently from the doctor. This study also revealed challenges that they face in general practice while managing patients with type 1 and 2 diabetes: frequency of HbA1c testing, Medicare billing guidelines, changing eligibility criteria, and lack of nurse recognition in collaborative care teams, emphasising the need for targeted education and training in diabetes management. In Study 3 patients reported greater satisfaction with nurseled care, noting differences in appointment availability and shorter appointment times with doctors. The results of Study 3 highlights the role of nurses in enhancing therapeutic relationships and improving patient outcomes. This PhD project highlights the significant advantages of nurse-led care in managing patients with type 1 and 2 diabetes. Increased patient satisfaction, improved care planning, and positive outcomes in HbA1c and glucose control demonstrate the effectiveness of nurses in addressing complex health needs. However, current Medicare funding frameworks impose limitations that prevent nurses from working to their full scope of practice because nurse-led care can only be provided as part of a general practitioner led team. Recognising the value of nurses' roles is essential in enhancing collaborative care, improving patient outcomes and reducing long-term complications. Providing education and support is important for nurses to optimise diabetes management in general practice.

Nurse-led care in managing adults with type 1 or 2 diabetes in general practice

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