Nurse-led clinics can boost quality scores

GPs could improve their quality framework score if they commission specialist nurse clinics for patients with CHD or chronic heart failure (CHF), UK research suggests.

The scheme could boost the number of CHF patients who receive a proper diagnosis and help CHD patients meet BP, cholesterol and therapeutic targets, said lead researcher and Leicester GP Dr Kamlesh Khunti.

For the study 1,316 patients with CHD or CHF were randomly assigned to attend clinics run by specialist nurses or standard care. The weekly clinics were run by two specialist secondary care nurses who travelled between the 20 Leicester practices attended by the patients.

Nurse intervention included patient assessment, confirmation of diagnosis, management of medicines and home visits. Nurses could refer patients to a secondary care cardiology clinic for echocardiography and assessment by a senior cardiologist.

At 12-month follow-up, CHD patients assigned to the specialist clinics were 61 per cent more likely to have a BP of 140/85mmHg and 58 per cent more likely to have total cholesterol levels below 5mmol/l.

Under the quality framework meeting this target is worth 36 points.

Patients with a history of MI were 43 per cent more likely to receive a beta-blocker if they received nurse intervention rather than standard care.

Additionally, CHF patients were around four times more likely to have a diagnosis of left ventricular systolic dysfunction (LVD) confirmed or excluded if they attended the clinics. Identifying and treating LVD is worth up to 20 points on the quality framework.

Although this study began in 2003, before introduction of the quality framework, Dr Khunti said its findings were applicable to current practice. For CHF management in particular, GPs should commission specialist nurse clinics.

‘Heart failure is a very difficult area to manage and you need more training to help make the diagnosis,’ he said.

In his area, secondary care nurses run clinics for CHF, while specialist practice nurses manage patients with CHD.

But Dr Terry McCormack, chairman of the Primary Care Cardiovascular Society and a GP in Whitby, Yorkshire, said specialist practice nurses could achieve the same outcomes.

‘The fact that it’s nurses doing it is not surprising because they’re especially good at achieving targets,’ he said.

The introduction of the GMS contract has also led to an overall improvement in these targets, he added.


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