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Nurse Care Manager Collaboration With Community-Based Physicians Providing Diabetes CareA Randomized Controlled TrialFrom the University of Michigan Medical School, Department of Medical Education (Dr Hiss, Ms Armbruster, Ms Gillard); University of Michigan School of Public Health, Department of Biostatistics (Dr McClure), Ann Arbor, Michigan. (Dr McClure's current address is Department of Biostatistics, University of Alabama at Birmingham.) Correspondence to Roland G. Hiss, University of Michigan, G1100 Towsley Center, Ann Arbor, MI 48109-0201 (redhiss{at}umich.edu). Purpose The purpose of this study was to demonstrate the potential value of close collaboration at the office level of a nurse care manager with community-based primary care physicians in the care of adult patients with type 2 diabetes, particularly those physicians not affiliated with an integrated care system that some managed care organizations provide. Methods Patients with type 2 diabetes were recruited from the general population of a large metropolitan area. Each received a comprehensive evaluation of his or her diabetes with results reported to patients and their physicians (basic intervention). A random one-half of patients were additionally assigned to individual counseling, problem identification, care planning, and management recommendations by a nurse care manager (individualized intervention). The patients receiving only the basic intervention served as the control group to those receiving the individualized intervention. Re-evaluation of all patients at 6 months after their entry into the study determined the effectiveness of the nurse-directed individualized intervention using A1C, blood pressure, and cholesterol as outcome measures. Results
Of 220 patients recruited, 197 had type 2 diabetes, randomly assigned only
the basic intervention (102 patients) or individualized intervention (95
patients). Postintervention data were obtained on 164 patients (83%).
Significant improvement occurred in mean systolic blood pressure and A1C of
all patients in the individualized but not the basic intervention only group.
Patients with a systolic blood pressure Conclusions A nurse care manager collaborating at the office level with community-based primary care physicians can enhance the care provided to adult patients with type 2 diabetes. For those many physicians not affiliated with an integrated care system featured by some managed care organizations, this collaboration could underlie a team approach (nurse/patient/physician) for the ambulatory patient with diabetes that would be an essential element in a chronic disease model of care for diabetes at the community level.
The Diabetes Educator, Vol. 33, No. 3,
493-502 (2007) |
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130 mm Hg at baseline showed
improvement if they had more than 2 contacts with the study nurse but not if
they had less than 2 contacts.