Nurse Monitoring Helpful for Patients with Chronic Illness

Results of a randomized trial reported in the December 30, 2010 issue of the New England Journal of Medicine support the important role of nurses in caring for patients with chronic illness. In order to be considered for the trial, patients had to be diagnosed with diabetes, coronary heart disease (or both), and needed to have one or more measures of poor disease control, such as high blood pressure, or high LDL or glycated hemoglobin levels. Patients from 14 primary care practices in Washington were randomized to receive usual care (primary care provided by physicians in accordance with the patients’ health maintenance plan) or a nursing intervention consisting of structured visits every 2-3 weeks. Nurses assessed and monitored patients’ disease control, self-care, and depression; guidelines were used to adjust medications when indicated.

Patients with chronic illnesses and coexisting depression had significantly better control of both conditions when nurses provided guideline-based care. Outcomes related to diabetes, hypertension, and dyslipidemia all improved significantly more with the nursing-based care versus usual care, and depression scores declined significantly. Patients also had better quality of life and were more satisfied with their care compared with patients who received usual-care.

This study supports the important role of nurses in caring for patients with chronic illness, and especially those with multiple chronic illnesses and co-existing depression. As the US moves forward with health care reform, I’m hoping that legislators and the public will embrace the idea of nurses in leadership roles when decisions are made about chronic care and how it should be provided. Nurses have the capabilities to do so many things in health care, and providing chronic care to patients is just one example.

Reference

Katon WJ, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010; 363: 2611-2620.