Nursing Online – May 2008

Nurses’ crucial role in primary care

More and more governments, policy-makers and corporations are realising that the most efficient and cost-efficient ways to make a sustained difference in our health and wellbeing are happening in the primary care sector. This renewed interest in the primary care sector presents new opportunities for nurses and midwives as well as challenges to the traditional hospital-focus of nursing preparation. This month Nursing Online presents a preview of important research that has been published recently by the Australian Primary Health Care Research Institute.

Review of Primary and Community Care Nursing
By Keleher, H., Parker, R., Abdulwadud, O., Francis, K., Segal, Dalziel, K.

Health care reform is driven by ageing populations and increasing levels of chronic and complex illness, reduction in access to general practitioners and workforce shortages. There is also pressure to improve accessibility of services to underserved groups and communities.
Strengthening the role of primary health care and prevention to enhance individual and population health outcomes is important to address the rise in chronic and preventable conditions.
Nurses are becoming increasingly central to the delivery of primary health care in Australia. Nurses working in primary health care can help address workforce shortages, improve access to health care and contribute to the management of chronic conditions and illness prevention.

A Systematic Review of Chronic Disease Management
By Zwar N, Harris M, Griffiths R, Roland M, Dennis S, Powell Davies G, Hasan I

Worldwide, chronic disease is on the rise, placing an increasing burden on those affected, their carers and the health system. In Australia many chronic diseases are predominantly managed in primary health care and there is a need to understand how to do this more effectively.
A systematic review was conducted on chronic disease management in primary health care using the Chronic Care Model (CCM) as the conceptual framework. Among the key findings are that self-management support, in particular, patient education and motivational counselling, improve physiological measures of disease as well other patient outcomes and that a multidisciplinary team-approach is effective in improving physiological measures of disease and health care professional’s adherence to disease management guidelines.

Optimising Skill Mix in the Primary Health Care Workforce for the Care of Older Australians: A Systematic Review
By Zwar, N., Dennis, S., Griffiths, R., Perkins, D., May, J., Hasan, I., Sibbald, B., Caplan, G. & Harris, M.

Australia has an ageing population resulting in demand for extensive and comprehensive care of chronic disease. Equipping the primary health care workforce to meet this demand has forced policy makers to consider if remoulding the workforce skill mix is a solution to meeting the health care needs of older Australians in the community. We conducted a systematic literature review to identify what sort of skill-mix changes in the primary care workforce could be successfully implemented to meet the health care needs of older Australians. Key findings included that task substitution between doctors and nurses improves health professionals’ adherence to guidelines and patients’ physiological measures of disease. The tasks that could be successfully substituted from doctors to nurses include case-management using guidelines, proactive patient follow-up, general patient consultation and support, care planning and goal setting, and patient self-management education. Nurse enhancement improves patients’ adherence to treatment, their quality of life and their functional status. The enhanced nursing roles that are likely to produce positive results include general patient consultations, patient home visits and support, care planning and goal settings, and patient self-management education.