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Nurse-led protocols provide quality care for hypertension, chronic disease
A recent study published in the Annals of Internal Medicine indicates that nurses can provide quality treatment, improve outcomes and lower the cost of resources in the management of hypertension, hyperlipidemia and diabetes.
The researchers wrote that 75% of all health care dollars spent in the US are directed toward the treatment of chronic illnesses, and many clinicians are looking for ways to reduce costs while providing quality care. In a meta-analysis of 18 studies — including 14 assessing BP outcomes (n=10,362), 15 evaluating hyperlipidemia outcomes (n=14,817) and 15 assessing diabetes outcomes (n=2,633) — researchers showed that nurses can effectively follow well-established protocols to improve patient outcomes in managing chronic diseases. Each of the studies involved nurses who prepared titrations, but not all studies included nurses permitted to initiate new medications. The study was funded by a V.A. Quality Enhancement Research grant.
BP outcomes
In BP studies, nurse-managed intervention resulted in a 3.68 mm Hg (95% CI, 1.05-6.31) decrease in systolic BP and a 1.56 mm Hg (95% CI, 0.36-2.76) decrease in diastolic BP.
Eleven studies were goal-based and focused on achieving a target BP. In analysis of randomized controlled trials only, nurse-managed protocols resulted in a higher likelihood of patients achieving the target BP vs. controls, but researchers wrote that these results were highly variable.
Hyperlipidemia outcomes
In nine of 11 randomized controlled trials assessing hyperlipidemia outcomes, nurse-managed intervention produced a decrease in total cholesterol of 9.37 mg/dL and a decrease in LDL of 12.07 mg/dL, but with “marked variability” in the effects of the intervention. However, in all 11 studies, target cholesterol levels were significantly more likely to be achieved through nurse-managed protocols vs. control protocols (OR=1.54; 95% CI, 1.02-2.31), though researchers noted substantial variability in effects of treatment (Q=71.59).
Diabetes outcomes
Ten randomized controlled trials included in the analysis targeted blood glucose levels. According to researchers, HbA1c was reduced by 0.4% among patients treated by nurse-managed protocols, though results were highly variable overall. One study showed a reduction in the number of patients with HbA1c concentrations ≥8.5%.
“Nurse-managed protocols in the studies we examined had a consistently positive effect on chronically ill patients. … Effects of nurse-managed protocols on lifestyle changes and medication adherence were reported infrequently, but when reported, they showed an overall pattern of small positive effects,” the researchers wrote.
Disclosure: Williams reports receiving grants from Veterans Affairs Health Services Research and Development during conduct of the study.