The impact of an assisted diabetes care programme on a private practice

ABSTRACT

Aims: Specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve diabetes outcomes in community health centres. We aimed to study the impact of a nurse-assisted diabetes care (NADC) model on diabetes and clinic's financial outcomes in a private practice setting.

Methods: Nurse-assisted diabetes care was provided to the diabetic patients referring to a Monday private diabetes clinic in Shiraz. 107 patients who had received such care were hierarchically matched with 107 diabetic patients receiving usual endocrinologist care in the same clinic during the rest of the week. At the end of 6 months of follow-up, outcomes [glycosylated haemoglobin (HbA_1c), serum triglycerides, low-density lipoprotein (LDL) cholesterol, duration of patient's visit and net clinic's income] for patients under NADC were compared with those of usual care patients and also with those derived from the 6 months before receiving NADC.

Results: Under NADC, HbA_1c levels had a more significant fall (p < 0.03), significantly smaller proportions of patients had triglyceride levels of > 1.69 mmol/l (150 mg/dl) and LDL cholesterol of > 2.58 mmol/l (100 mg/dl) (both p < 0.05), the time for one patient's visit decreased by an average of 9.3 min (p = 0.000) while the clinic's net income increased by 21.25%.

Conclusion: Nurse-assisted diabetes care, while improving diabetes outcomes significantly, spares time for the physician and allows more patients to be seen per clinic hours. The excess income from extra visits much outweighs the expenditures including the nurses' wages. NADC is profitable for private diabetes clinics or offices.