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Promoting Health in Type 2 Diabetes: Nurse-Physician Collaboration in Primary Care

Calgary Health Region; Alberta, Canada.

Kathleen M. Oberle, RN, PhD

Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada T2N 1N4; phone: 403-220-6268; fax: 403-284-4803;oberle{at}ucalgary.ca

Rodney A. Crutcher, MD, CCFP

Department of Family Medicine; Alberta, Canada.

Peter G. Norton, MD, CCFP

Department of Family Medicine at the University of Calgary, Alberta, Canada.

The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study. Forty patients from a family practice clinic with type 2 diabetes were randomly assigned to control or experimental groups. The control group received standard care, whereas the experimental group received standard care plus home visits from a nurse, as well as consultation with an exercise specialist and/or nutritionist. Follow-up continued for 3 months. Clinical end points included standard measures of diabetes activity as well as quality-of-life indicators. Focus group interviews were used to explore patients’ responses to the program. Although findings were not statistically significant, a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure. Quality oflife measures also showed a trend toward small to moderate, but nonsignificant, improvements in physical functioning, bodily pain, vitality, social and global functioning, energy, impact of diabetes, and health distress. Focus group interviews indicated a very positive response from patients, who expressed feelings of empowerment. In this study, patients treated with nurse-physician collaboration demonstrated small, but nonsignificant, improvements in blood chemistry after only 3 months. Physical and social functioning, energy, and bodily pain also showed a small improvement. Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term.

Key Words: advanced practice nursing • diabetes care • collaborative practice • nursing research

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