Australian practice nurses' perspectives on integrating specialist diabetes care with primary care: a qualitative study

Abstract

Background: In 2015, the Australian Diabetes Alliance Program (DAP) was implemented in the Hunter New England Local Health District, New South Wales as a collaboration with the Hunter Medicare Local. DAP integrates specialist teams within primary care practices, delivering case conferencing, practice performance reviews, and education sessions.

Objective: To report on practice nurses (PNs) perspectives on the impact of the DAP on their skills, knowledge, and approach in delivering care for adults with type 2 diabetes.

Methods: Three primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and three practices with lower rates of monitoring HbA1c levels (< 80% of patients annually) from DAP provided the sampling frame. Interviews were conducted with six PNs, which were transcribed and analysed using codebook thematic analysis.

Results: Overall, DAP was viewed favourably by PNs. Significant improvements in knowledge and skills were reported relating to administering antihyperglycemic agents, insulin, and other injectable therapy, as well as dietary modifications for diabetes management. PNs transferred this knowledge and skills to other patients not participating in DAP. An improvement in the delivery of diabetes care, rather than a change in approach, was also reported by PNs. However, the amount of preparation required for case conferencing in the program was identified as a burden to PNs.

Conclusions: PNs were supportive of DAP and identified knowledge gains that were transferable to other patients. The administrative burdens on PNs need to be considered for scalability of the program.

Keywords: delivery of health care; diabetes mellitus; integrated; nurses; primary care nursing; primary health care; qualitative research.