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BMC Health Services Research

, 10:230

First Online: 06 August 2010Received: 01 April 2010Accepted: 06 August 2010DOI: 10.1186-1472-6963-10-230

Cite this article as: van Dijk, C.E., Verheij, R.A., Hansen, J. et al. BMC Health Serv Res 2010 10: 230. doi:10.1186-1472-6963-10-230


BackgroundPrimary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II T2DM patients has changed with the introduction of primary care nurses, and whether these changes were related to the number of diabetes-related contacts in a general practice.

MethodsHealthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that participated in the Netherlands Information Network of General Practice LINH. Multilevel logistic and linear regression analyses were used to analyse the effect of the introduction of primary care nurses on referrals to internists, ophthalmologists and cardiologists and diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known T2DM patients.

ResultsReferrals to internists for newly diagnosed T2DM patients decreased between 2004 and 2006 OR:0.44; 95%CI:0.22-0.87 in all practices. For known T2DM patients no overall decrease in referrals to internists was found, but practices with a primary care nurse had a lower trend OR:0.59. The number of diabetes-related contacts did not differ between practices with and without primary care nurses. Cardiologists- and ophthalmologists- referral rate did not change.

ConclusionsThe introduction of primary care nurses seems to have led to a shift of care from internists to primary care for known diabetes patients, while the diabetes-related contact rate seem to have remained unchanged.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-10-230 contains supplementary material, which is available to authorized users.

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Autor: Christel E van Dijk - Robert A Verheij - Johan Hansen - Lud van der Velden - Giel Nijpels - Peter P Groenewegen - Dinny 


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