Comparison of the role of physician and advance nurse practitioner in influencing outcomes of patients with diabetic disease in a primary health care centre

DISSERTATION PROPOSAL
Comparison of the role of physician and advance nurse practitioner (APN) in influencing
outcomes of patients with diabetic disease in a primary health care centre
Dissertation Research
Riyadh, Saudi Arabia.

PAGE \*DISSERTATION PROPOSAL
Abstract:
The main aim of this research proposal is to the care outcomes obtained by of physician
and advanced nurse practitioner (ANP) in in influencing care outcome of patients with diabetes
in primary care. The rationale for research is to examine how care can be better management in
primary care settings in the community rather than acute care setting. Primary care service is the
central point of access for people with diabetes to seek care. However, shortage of GPs and
disparities in access to GP-led primary care service for people with diabetes suggest the need to
adapt newer care model to enhance health outcome of people with diabetes. New researchers
have suggested the possibility of the role of advanced nurse practitioners (APN) in addressing
accessibility and efficacy issues related to the management of diabetes and achieving outcomes
like glycemic control, blood pressure and cholesterol levels. As there is great argument regarding
the fact that whether physicians should be substituted with APN in primary care or not, the need
for comparison on the role of nurse versus physician in influencing outcome of diabetes patient
has become important. This research proposal provides an insight into the rationales for research,
key aims and objectives of the review. The paper also provides a literature review on the topic to
gain supporting articles for the proposed practice base change and the importance of
retrospective research design in getting clear idea about the benefit of APN in influencing health
outcome of people with diabetes in primary care setting.

PAGE \*DISSERTATION PROPOSAL
Table of Contents
Overview: 3
Problem statement: 4
Hypothesis: 6
Research rationale: 6
Research question: 7
Aim and objectives: 8
Summary: 8
Literature review: 9

PAGE \*DISSERTATION PROPOSAL
Background:
Diabetes is a chronic disease condition associated with failure in glucose control and risk
of other chronic disease conditions like cardiovascular disease and strokes. The global
prevalence of diabetes is understood from the fact that the number of people with diabetes has
increased from 108 million to 422 million in 2014. The burden of diabetes is understood from
the fact that diabetes has been the cause behind 1.6 million deaths in 2014 (World Health
Organization 2018). As it is expected that the prevalence rate is likely to increase to 693 million
by 2045, finding a cost-effective way to control diabetes and treat people already diagnosed with
diabetes is important. This would be beneficial in reducing health care expenditure due to
diabetes and the financial and health system burden across the world (Cho et al. 2018).
The common issue encountered by people with diabetes is that they fail to achieve the
recommended outcome variable of cholesterol, blood pressure, and blood sugar level. As
primary care centre has become the central point for diabetes management, reviewing the
provisions and process of care provided by primary care physician and APNs have become
important. Physicians in primary care now actively take part in providing diabetic care to
patients with diabetes. In addition, new nurse suggests that a primary care practice model in
which nurses takes the lead in diabetes management is critical because of low availability of GPs
in remote location and poor access to GP led service for disadvantaged groups (Seidu et al.
2017). Current research also suggests the need to promote collaboration between physicians and
APNs in primary care so that both can work together to provide comparatively high-quality
primary care to patients (Murrells et al. 2015). However, as the benefit of physician’s
substitution with that of a nurse practitioner is disputed, proper research on the comparison

PAGE \*DISSERTATION PROPOSAL
between physician’s and nurse’s role in influencing the outcome of people with diabetes is
considered important. Hence, this proposal aims to compare and contrast the outcomes achieved
by the involvement of physicians and APN to review what role they play in achieving gylcemic
control and optimal blood pressure level in patients with diabetes visiting primary care setting.
Problem statement:
There are various inherent problems found in primary care that has affected the quality of
care and health outcomes for people with diabetes. The first issue is that all people with diabetes
do not receive equal access to GP led care. Buja et al. (2014) give the evidence that as the
number of people with diabetes is rising, there is a need for greater action of the primary care
team and coordination of patient care. However, the study by Riordan et al. (2017) shows that
there is a greater need for participation of nurse in case as GPs is not readily available in all
primary care setting. This new proposition requires analysis to understand whether APNs are
equally positioned or better positioned than GPs in promoting optimal health outcome for people
with diabetes or not. Hence, the research topic is important to evaluate the contribution of
physician and APN in influencing diabetes care in primary setting. The evaluation of the role of
APN and physician would also help to identify areas where more training or coordinated action
is needed to ensure positive health outcome (gylcemic control, normal cholesterol and normal
blood pressure) is achieved for people with diabetes.
Shortage of physician in primary care is also a challenge which affects the vision of
improving the quality of life of people with diabetes. In resource-limited countries, primary care
physicians are the main providers of diabetes care. Norful et al. (2017) give the evidence that
current health care models are challenged by physician shortage and due to such issues,

PAGE \*DISSERTATION PROPOSAL
clinicians and policymakers are suggesting team-based care models. Hence, there is a possibility
can APN can become a necessary part of team based models of care. As such low-income
countries also suffer from challenges because of a shortage of specialist staff, in such scenario
primary care physicians should be highly capacitated to address the rising demand for diabetic
care. However, inconsistent practices related to diabetes diagnosis, evaluation and management
among care providers, poor utilization of primary care service by diabetes patients and limited
consultation time suggest the need to review skills and efficacy of physicians in diabetes
management again (Jingi, Nansseu and Noubiap 2015). As there is lack of research on the
aptitude of health care providers related to diabetes care, evaluating and comparing studies
related to the diabetes related outcomes achieved by physicians and APNs in treating diabetes
patient in primary care is vital. Comprehensive research and literature review will help to
understand gaps in current research related to achieving optimal gylcemic control and blood
pressure control. It will also suggest the role of retrospective chart review in comparing and
differentiating the outcome achieved for diabetes patient in primary care setting when care is
delivered by APNs and physicians.
Hypothesis:
The research hypothesis is that the advanced nurse practitioners are well equipped to
improve the health outcome of people with diabetes. This hypothesis has been made because
APNs have competencies related to direct clinical skills and they have been able to maintain
optimal glycaemic level in diabetes patient, reduce cholesterol and blood pressure in primary
care setting (Cooke, Gemmill and Grant 2008). the expectation that nurses spend more time with
people in care and they can work to individual manage challenges faced by the diabetic patient in
adhering to treatment guideline. Murrells et al. (2015) give the evidence that specialist nurse is