Measuring the Impact of Nurse Practitioners on the outcomes of Care for Diabetic Patients in Primary Care

Running head: Proposal
Measuring the Impact of Nurse Practitioners on the outcomes of Care for Diabetic Patients in
Primary Care.

1Proposal
Table of Contents
Introduction:....................................................................................................................................2
Background:.....................................................................................................................................2
Statement of the problem:................................................................................................................4
Hypothesis:......................................................................................................................................6
Research rationale:...........................................................................................................................7
Research question:...........................................................................................................................7
Aim and objectives:.........................................................................................................................8
Summary:.........................................................................................................................................8

2Proposal
Introduction:
Diabetes is a worldwide epidemic with an alarming increase in diagnosis of the condition
in various countries. The global burden of diabetes is increasing with an estimated 1.6 million
deaths caused by diabetes in 2016.As the number of people diagnosed with diabetes has
increased with time, it is estimated that by 2045, prevalence rate of diabetes is likely to reach 693
people (World Health Organization 2018). This would mean large of patient visit for diabetes
related problem and huge pressure on the primary care setting. Primary care setting is the first
point of care for community people diagnosed with diabetes or at risk of diabetes. Shrivastav et
al. (2018) revealed increasing demand for the primary care professionals as they deliver clinical
care to 90% of individuals with diabetes. Hence, as the diabetes population increasing,
evaluating the contribution and role of nurse practitioners in successfully managing patients in
primary care is necessary. This would help to improve the provision of integrated care and
reduce the problem of general practitioners (GP) shortage in primary care. As recent evidences
shows that potential of nurse led clinics in primary care, conducting research to measure the
impact of nurse practitioners on influencing diabetes related outcome in primary care is
necessary. The main purpose of this research is to examine the impact of nurse practitioners (NP)
on quality and outcomes of diabetes care in community.
Background:
Diabetes is a type of disease condition that is associated with range of complications that
endanger health and survival of people and significantly increases the risk of medical
expenditure due to high health care cost. It is a major cause of mortality and disability globally
(Krug, 2016). Some of the major issues for people living with diabetes is they lack access to

3Proposal
necessary medication or information. Other issues present in primary care that influence health
outcome of people living with diabetes is that large number of individuals receive their primary
care from non-physician clinician due to decrease in number of primary care physician and rural-
urban disparity in physician distribution (Kuo et al. 2015). Primary care physicians play a major
role in meeting psychosocial, medical and educational needs of people with diabetes. However,
they fail to achieve optimal glycemic level in diabetic patient because of high patient load,
patient diversity, language differences and failure to initiate therapy. However, Richardson et al.
(2014) gave the evidence that NPs can improve clinical outcomes of diabetes patient in primary
care practice as they have the skills to initiate, change and adjust medications. Hence, their
involvement in primary care setting can be vital to improve the quality of care and glycemic
target of patient.
As Richardson et al. (2014) revealed the potential of NPs in providing appropriate care to
diabetic patient, using robust design to measure the impact of NPs in improving HbA1c level,
BP, cholesterol level can help to rationalize the need for recruitment of more number of NPs in
primary care. This research will also favour adaptation of new models of care. Current researcher
regard for nurse-led model of care as an appropriate method for effective management of
diabetes . Clinical trials done in 2006 have revealed nurse can provide high quality primary care
compared to that of primary care medical staffs (Murrells et al. 2015). However, this finding
cannot be directly used to increase nurse’s involvement in primary care for diabetes as this has
not been done in diverse setting. As there is lack of evidence regarding the nurses contribution in
influence quality of diabetes care in a routine basis, using strong research design to rationalize
the need for substituting GPs with primary care nurse in primary care setting is necessary. The
significance of research on this topic is also understood from the fact currently there is growing

4Proposal
interest in using nurse to expand the capacity of primary care workforce. This interest is seen
because of current problem likes ageing and prevalence of chronic disease which is increasing
the demand of primary care services (Laurant et al., 2018).
The need for nurse to assume greater role in diabetes management in clinical care is
necessary because of global shortage of health care workforce in relation to patient population.
Physician shortage is common problem in primary care because of disparities in availability of
GP in rural and urban areas, changes in the working culture and trends in retirement. Martínez-
González et al. (2015) argues that finding newer solutions such as granting full practice and
greater role to nurse to overcome work shortage. One of the advantages of involving nurses in
primary care is they are the largest group of qualified and competent health care professionals
and they are less expensive compared to physicians. Hence, this research will be critical in
providing valid evidence regarding the impact of nurse in promoting control of glycemic, BP and
cholesterol level. Evaluation of NP’s action in the achievement of this outcome will increase
interest of policy makers and health care managers in substituting physician and integrating
nurses in the primary care. The research can also help to understand how nurse can be effectively
integrated in primary care setting to improve health and quality of care for people with diabetes.
Statement of the problem:
The rationale for research in this area is understood from several problem present in the
health care setting currently. Current challenges in primary care setting are the high demand of
diabetes patients in primary care and lack of equal access to care for people living with diabetes.
Primary is a vital setting for newly diagnosed diabetes patients and patients at risk of diabetes to
receive care and support for management of the condition. Primary health care professionals play

5Proposal
a major role in screening, providing lifetime advice and improving their health behaviour.
However, the quality of care for people with diabetes is seriously affected because of several
disparities in primary care management of diabetes. Buja et al. (2014) gives the insight that with
the increase in ageing population, the demand for care is rising because of the prevalence of
chronic disease like diabetes. In such situation, the role of the primary care team is to effectively
organize and coordinate patient care. However, this does not occur because of disparities in the
availability of GPs in primary care. Norful et al. (2017) suggest that physician shortage is a
critical issue in primary care as it increases strain on the health care system. Hence, investigation
about the impact of nurse on diabetes management is critical to shift from traditional model of
care and adapt new model of care to overcome challenges in disease management.
As per the traditional model of care, single physician is involved in the management of
patients with diabetes. They are assigned to provide care to a sub-group of population in the
community. However, the ratio of GPs may not be accurate in all setting to handle huge influx of
patients with diabetes related issues. Hence, to alleviate this burden present in primary care,
researching on nurse’s competency in diabetes management is critical facilitate acceptance of
nurse-led model of care in primary care setting. As NPs are capable of delivering high quality
care, getting validated data related to their influence of diabetes patient’s outcome would help to
alleviate challenges in care delivery (Norful et al., 2017). Although physicians provide care to
diabetes patients in large numbers, individual NPs are likely to achieve same clinical outcome
for diabetes patient compared to GPs. As the rate of NPs is expanding in developed countries,
using strong research design to evaluate NPs competency in diabetes management would
facilitate achieve optimal health outcomes for patient with diabetes.