Quality of Care for Patients With Diabetes and Mulitmorbidity Registered at Nurse Practitioner-Led Clinics

Abstract

Background

Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model.

Purpose

Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics.

Methods

An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines.

Results

Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.

Keywords

Diabetes nurse practitioners primary care

Get full access to this article

View all access options for this article.

References

Agarwal, G., Kaczorowski, J., & Hanna S. (2012). Care for patients with type 2 diabetes in a random sample of community family practices in Ontario, Canada. International Journal of Family Medicine, 2012, 734202. doi:10.1155/2012/734202.

Allison

J. J.

Wall

T. C.

Spettell

C. M.

Calhoun

Fargason

C. A.

Kobylinski

R. W.

Kiefe

(2000) The art and science of chart review. Journal on Quality Improvement 26(3): 115–136.

Association of Family Health Teams of Ontario. (2016). Value of eHealth in Ontario. Retrieved from https://files.ontario.ca/18._association_of_family_health_teams_of_ontario.pdf.

Bower

Macdonald

Harkness

Gask

Kendrick

Valderas

J. M.

Sibbald

(2011) Multimorbidity, service organization and clinical decision making in primary care: A qualitative study. Family Practice 28(5): 579–587. doi:10.1093/fampra/cmr018.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2013) Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes 37(suppl 1): S1–S212. Retrieved from http://guidelines.diabetes.ca/app_themes/cdacpg/resources/cpg_2013_full_en.pdf.

Canadian Health Services Research Foundation. (2012). Evidence synthesis for the effectiveness of interprofessional teams in primary care. Retrieved from https://www.cna-aiic.ca/∼/media/cna/files/en/synthesisinterprofteams_jacobson-en-web.pdf.

Dahrouge

Hogg

Russell

Geneau

R. R.

Kristjansson

Muldoon

L. L.

Johnston

(2009) The comparison of models of primary care in Ontario (COMP-PC) study: Methodology of a multifaceted cross-sectional practice-based study. Open Medicine 3(3): e149.

DiCenso, A., Bryant Lukosius, D., Bourgeault, I., & Treloar, C. (2010). Clinical nurse specialists and nurse practitioners in Canada. Retrieved from http://www.cfhi-fcass.ca/sf-docs/default-source/commissioned-research-reports/Dicenso_EN_Final.pdf?sfvrsn=0.

Donabedian, A. (2003). An Introduction to Quality Assurance in Healthcare. Oxford; Oxford University Press.

10.

Edwards

Rowan

Grinspun

(2011) Understanding whole systems change in health care: The case of nurse practitioners in Canada. Policy, Politics, & Nursing Practice 12(1): 4–7. doi:10.1177/154411403816.

11.

Fortin

Soubhi

Hudon

Bayliss

E. A.

Akker

M. V. D.

(2007) Multimorbidity’s many challenges. British Medical Journal 334(7602): 1016–1017. doi:10.1136/bmj.39201.463819.2C.

12.

Grimshaw

J. M.

Russell

I. T.

(1993) Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations. Lancet 342(8883): 1317–1322.

13.

Harris

S. B.

Worrall

Macaulay

Norton

Webster-Bogaert

Donner

Stewart

(2006) Diabetes management in Canada: Baseline results of the group practice diabetes management study. Canadian Journal of Diabetes 30(2): 1–7. doi:10.1016/S1499-2671(06)02005-3.

14.

Heale

(2012) Overcoming barriers to practice: A nurse practitioner-led model. Journal of the American Academy of Nurse Practitioners 24(6): 358–363. doi:10.1111/j.1745-7599.2012.00737.x.

15.

Holroyd-Leduc

J. M.

Lorenzetti

Straus

S. E.

Sykes

Quan

(2011) The impact of the electronic medical record on structure, process, and outcomes within primary care: A systematic review of the evidence. Journal of the American Medical Informatics Association 18(6): 732–737. doi:10.1136/amiajnl-2010-000019.

16.

Hurlock-Chorostecki

Forchuck

Orchard

Reeves

van Soeren

(2013) The value of the hospital-based nurse practitioner role: Development of a team perspective framework. Journal of Interprofessional Care 27(6): 501–508. https://dx-doi-org.web.bisu.edu.cn/10.3109/13561820.2013.796915 .

17.

McCurdy, B., MacKay, C., Badley, E., Veinot, P., & Cott, C. (2008). A proposed evaluation framework for chronic disease prevention and management initiatives in Ontario (pp. 1–95). Retrieved from http://www.acreu.ca/pdf/pub5/08-02.pdf.

18.

Ministry of Health and Long-Term Care. (2015). Nurse Practitioner-Led Clinics. Retrieved from http://www.health.gov.on.ca/en/common/system/services/npc/.

19.

North East Local Health Integration Network. (2013). Integrated health Service Plan 2013–2016. Quality Healthcare when Northerners Need It.

20.

North Simcoe Muskoka Local Health Integration Network. (2013). Integrated Health Service Plan 2013–2016. Healthy People. Excellent Care. One System.

21.

Ontario Pharmacists Association. (2016). Universal Influenza Immunization Program. Retrieved from https://www.opatoday.com/professional/resources/for-pharmacists/programs/uiip.

22.

Simmons

Kapustin

J. F.

(2011) Diabetes group visits: An alternative to managing chronic disease outcomes. The Journal for Nurse Practitioners 7(8): 671–679. doi:10.1016/j.nurpra.2010.12.002.

23.

Smith

O’Kelly

O’Dowd

(2010) GPs’ and pharmacists’ experiences of managing multimorbidity: A ‘Pandora’s box’. British Journal of General Practice 60: e285–e294.

24.

Stellefson

Dipnarine

Stopka

(2013) The chronic care model and diabetes management in US primary care settings: A systematic review. Preventing Chronic Disease 10: E26. doi:https://dx-doi-org.web.bisu.edu.cn/10.5888/pcd10.120180.

25.

Russell

G. M.

Dahrouge

Hogg

Geneau

Muldoon

Tuna

(2009) Managing chronic disease in Ontario primary care: The impact of organizational factors. The Annals of Family Medicine 7(4): 309–318. doi:10.1370/afm.982.

26.

Russell

Dahrouge

Tuna

Hogg

Geneau

Gebremichael

(2010) Getting it all done. Organizational factors linked with comprehensive primary care. Family Practice 27(5): 535–541. doi:10.1093/fampra/cmq037.

27.

Virani

(2012) Interprofessional Collaborative Teams. Canadian Health Services Research Foundation. 1–142. Retrieved from http://www.cfhi-fcass.ca/Libraries/Commissioned_Research_Reports/Virani-Interprofessional-EN.sflb.ashx.

28.

Wagner

E. H.

Austin

B. T.

Davis

Hindmarsh

Schaefer

Bonomi

(2001) Improving chronic illness care: Translating evidence into action. Health Affairs 20(6): 64–78. doi:10.1377/hlthaff.20.6.64.

29.

Watts

S. A.

Gee

O’Day

M. E.

Schaub

Lawrence

Aron

Kirsh

(2009) Nurse practitioner-led multidisciplinary teams to improve chronic illness care: The unique strengths of nurse practitioners applied to shared medical appointments/group visits. Journal of the American Academy of Nurse Practitioners 21(3): 167–172. doi:10.1111/j.1745-7599.2008.00379.x.

30.

World Health Organization. (2010). Global status report on noncommunicable diseases 2010. Retrieved from http://apps.who.int/iris/bitstream/10665/44579/1/9789240686458_eng.pdf.

31.

Zhang

J. Q.

Van Leuven

K. A.

Neidlinger

S. H.

(2012) System barriers associated with diabetes management in primary care. TJNP: The Journal for Nurse Practitioners 8(10): 822–827. doi:10.1016/j.nurpra.2012.02.02.