Nurse-led chronic-condition care could offset primary care shortage

Giving nurses a larger role in care for chronic conditions such as high blood pressure, high cholesterol and diabetes could help offset the primary care physician shortage, according to a new study published in the Annals of Internal Medicine.

Researchers, led by Ryan J. Shaw, Ph.D., reviewed 18 studies on registered nurses' effectiveness in leading management of the three chronic conditions, six of which were randomized controlled trials. Nurses in all 18 studies were able to change doses of medications prescribed by physicians, and nurses in 11 could independently start patients on new ones. Patients with nurse-managed care had overall better blood sugar management, lower blood pressure and steeper reductions in LDL cholesterol, Shaw and his team found. The researchers also found no adverse outcomes to speak of, Shaw told Reuters.

To perform this type of care, Shaw told Reuters, nurses would work on a team with physicians, pharmacists and other healthcare professionals. "They're not practicing by themselves," he said. "They're just extending the care that you might get from a physician."

However, researchers noted, the study is limited by factors, such as limited descriptions of treatment and nurse training levels, in the research they reviewed, and most of the studies were conducted in Western Europe, meaning their results might not be applicable to the United States' healthcare system.

Regardless of these limitations, "outpatient medicine has become too complicated for physicians to handle by themselves," Sandeep Jauhar, M.D., Ph.D., and David Battinelli, M.D., wrote in an accompanying opinion piece. We need new models of primary care, and enlisting nurses will be central to this effort."

A 2013 study found that consumers favor an expanded role for nurses and physician assistants (PAs), with a majority of respondents saying they would choose to see a nurse practitioner or a PA sooner rather than a doctor later, FierceHealthcare previously reported.

To learn more:
- here's the study abstract
- read the Reuters article
- read the opinion piece

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