Diabetes Management By Primary Health Care Nurses In Auckland, New Zealand

Abstract

DIABETES MANAGEMENT BY PRIMARY HEALTH CARE NURSES IN AUCKLAND, NEW ZEALAND Aim: Identify the key issues in the clinical management of diabetes patients by Primary Health Care (PHC) nurses. Methods: PHC nurses in Auckland (a 26% random sample) were asked to complete postal and telephone questionnaires, on education, experience, knowledge and diabetes management practice, and log care given to diabetes patients on a randomly selected day (n=265). Findings: Responses were received from 287 PHC nurses (86% response rate) comprising 210 practice nurses (PN), 49 district nurses (DN) and 28 specialist nurses (SNs). Most nurses (96%) were able to identify excess body weight as a major risk factor for type 2 diabetes and elevated blood glucose levels (BGLs) or glycosylated haemoglobin (HbA1c) (86%) for diabetes-related complications. In contrast, cardiovascular (CV) risk factors were less well identified, particularly smoking, although more by SNs (43%) than PNs (14%) and DNs (12%, p=0.0005). CV complications, especially stroke, were less well known than microvascular complications, and by significantly fewer PNs (13%) and DNs (8%) than SNs (36%, p=0.002). Stronger associations were found between nurse’s knowledge of elevated HbA1c as a risk factor for diabetes-related complications and management activities related to BGLs and medication, compared with knowledge of CV risk factors, which was not associated with assessment of blood pressure or knowledge of patient’s total cholesterol or smoking status. The median number of patients consulted on the randomly selected day was one by 38% of PNs, two by 47% of DNs and 4-5 by 57% of SNs. Overall, PNs consulted almost 60% of the patients sampled, while patients consulted by DNs were older and more likely to be European New Zealanders, tobacco uses and have diabetes-related complications and co-morbidities, while SNs consulted more Maori patients. Relevance: There is a need for PHC nurses to increase their knowledge of CV risk factors with more effective management required and particularly of smoking.