Implementing Effective Care Through Utilization of Diabetes-Focused "Right Care" Visits in a Suburban Primary Care Setting.

IF 0.2 Q4 NURSING
Tricia Neu, Christopher Eppley, Kristin Gianelis
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Abstract

Background: Diabetes is the seventh leading cause of death in the United States and the leading cause of lower limb amputations, adult-onset blindness, and renal failure. It is estimated that 34.2 million Americans have a diabetes diagnosis, and the prevalence of this condition has continually increased over the last two decades. This study includes patients at a large, suburban primary care practice in southwest Ohio who were considered to have uncontrolled diabetes based on their last Hemoglobin A1c of greater than 9%. Compliance with recommended annual screenings among this population was 15%. Objectives: The aim of this project was to improve glycemic control and increase the number of patients who received the recommended annual screenings through the implementation of nurse practitioner-driven, diabetes-focused "Right Care" visits.C Methods: This quality improvement pilot study consisted of interventions implemented over the four plan-do-study-act cycles. Each cycle included a test of change that was identified based on data from previous cycles to ensure continuous improvement throughout project implementation. Four interventions were evaluated including the utilization of a diabetes registry, implementation of a "Right Care" checklist during "Right Care" visits, use of a patient engagement tool with a focus on individualizing diabetes medication regimens, and implementation of a team-engagement plan. Results: Average Hemoglobin A1c reduction was 2.4% post-"Right Care" visit. Compliance with the annual screening bundle increased to 44% over 8 weeks. Utilization of the patient/provider relationship increased visit compliance by 18%, and the team engagement plan decreased work-related stress by 12%. Conclusions: The implementation of "Right Care" visits led to improved glycemic control and increased compliance with the recommended annual screenings among patients with an A1c greater than 9%. The patient engagement tool identified key factors related to diabetes medication adherence and team engagement decreased work-related stress and improved annual fundoscopic exam screening compliance. Implications for Nursing: Nurse practitioner-led "Right Care" visits utilize the knowledge and skills of advanced practice registered nurses to improve glycemic control in patients with uncontrolled diabetes.

在郊区初级保健设置中,通过利用以糖尿病为中心的“正确护理”访问来实施有效的护理。
背景:糖尿病是美国第七大死亡原因,也是导致下肢截肢、成人致盲和肾衰竭的主要原因。据估计,3420万美国人被诊断患有糖尿病,并且在过去的二十年中,这种疾病的患病率不断增加。本研究纳入了俄亥俄州西南部一家大型郊区初级保健诊所的患者,这些患者根据其最后一次血红蛋白A1c大于9%被认为患有未控制的糖尿病。在这些人群中,每年推荐筛查的依从性为15%。目的:该项目的目的是改善血糖控制,并通过实施护士驱动的、以糖尿病为重点的“正确护理”访问来增加接受推荐的年度筛查的患者数量。方法:这项质量改善试点研究包括四个计划-研究-行动周期的干预措施。每个周期都包括一个基于前一个周期的数据确定的变更测试,以确保在整个项目实施过程中不断改进。评估了四项干预措施,包括糖尿病登记的使用,“正确护理”访问期间“正确护理”清单的实施,患者参与工具的使用,重点是个性化糖尿病药物治疗方案,以及团队参与计划的实施。结果:“正确护理”后平均糖化血红蛋白降低2.4%。在8周内,年度筛查包的依从性增加到44%。利用医患关系使就诊依从性提高了18%,团队参与计划使工作压力降低了12%。结论:在糖化血红蛋白大于9%的患者中,“正确护理”就诊的实施改善了血糖控制,增加了对推荐的年度筛查的依从性。患者参与工具确定了与糖尿病药物依从性和团队参与相关的关键因素,减少了工作压力,提高了每年的眼底检查筛查依从性。对护理的启示:执业护士主导的“正确护理”访问利用高级执业护士的知识和技能来改善未控制糖尿病患者的血糖控制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
0.60
自引率
0.00%
发文量
45
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