2.50
Hdl Handle:
http://hdl.handle.net/10755/158221
Type:
Presentation
Title:
Differentiated practice: Primary care of diabetic adults
Abstract:
Differentiated practice: Primary care of diabetic adults
Conference Sponsor:Western Institute of Nursing
Conference Year:2001
Author:Lenz, Elizabeth, PhD
P.I. Institution Name:Columbia University
Title:Associate Dean
Contact Address:School of Nursing, 630 West 168th Street, New York, NY, 10032, USA
Contact Telephone:212.305.5538
Statement of Need. While the term "differentiated practice" is commonly used to refer to the dissimilar approaches, diagnoses and interventions used by nurse practitioners and physicians in patient encounters, the nature and extent of this differentiation has not been thoroughly described or quantified in recent years. Nurses and physicians are socialized differently, and their basic education is guided by different models of the patient, illness/wellness and practice; hence it is often assumed that they must behave differently in the primary care arena, even though education for advanced nursing practice tends to draw heavily on the medical model. Currently there is little evidence to substantiate that this is the case. If advanced practice nurses are to continue to claim that they practice somewhat differently from physicians and bring a value added dimension to primary care, it is essential that the extent of differentiation in practice begin to be documented. The purpose of this study is to examine the extent to which NP's and MD's differ in the processes they employ in managing diabetic adults in the primary care setting. Description of Sample. The sample was comprised of the 98 diabetic patients who had been recruited for a larger randomized study comparing NP and MD patient outcomes. Potential subjects were referred from emergency and urgent care centers and were enrolled only if they reported no regular source of primary care and were willing to be randomized to either an independent NP primary care clinic or one of four MD-run primary care clinics in an urban academic medical center. The sample was 92.8% Hispanic and 67.3% female, and 51% also reported a diagnosis of hypertension. Method. Data were obtained through chart audits conducted by research nurses on site in the five clinics. The review was carried out according to a standardized format and included chart entries during the first 6 months of enrollment in the practice. The data collection instrument required the chart reviewer to indicate (yes/no) whether the record included evidence of specific monitoring, screening, referral, and patient education behaviors that were derived from standards for diabetes management. Inter-rater reliability was checked periodically throughout the chart review. NP-MD comparisons were analyzed using Chi Square (SPSS). Results. Chart audits revealed that NP's exhibited more frequent monitoring behaviors than MD's, specifically urinalysis (79.7% vs 56%) and serum glucose monitoring (71.2% vs 51.3%). Physicians were more likely to refer patients to an ophthalmologist (56.4% vs 35.6% for NPs). NPs were more likely than MDs to chart that they provided general diabetes education, including nutrition, exercise, foot care, and medications (72.9% vs 38.5%). Conclusions. This study provided preliminary evidence that it is possible to quantify differentiated practice using data from chart audits. Admittedly a major limitation is that the audits reflect only those behaviors that are documented by the provider. However, the audit indicated that NPs documented more screening and education behaviors, and MDs documented more specialty referrals. The differences in preventive screening and education are consistent with the strong emphasis on prevention and education in nursing.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDifferentiated practice: Primary care of diabetic adultsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158221-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Differentiated practice: Primary care of diabetic adults</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Lenz, Elizabeth, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Columbia University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Dean</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, 630 West 168th Street, New York, NY, 10032, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">212.305.5538</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">erl13@columbia.edu</td></tr><tr><td colspan="2" class="item-abstract">Statement of Need. While the term &quot;differentiated practice&quot; is commonly used to refer to the dissimilar approaches, diagnoses and interventions used by nurse practitioners and physicians in patient encounters, the nature and extent of this differentiation has not been thoroughly described or quantified in recent years. Nurses and physicians are socialized differently, and their basic education is guided by different models of the patient, illness/wellness and practice; hence it is often assumed that they must behave differently in the primary care arena, even though education for advanced nursing practice tends to draw heavily on the medical model. Currently there is little evidence to substantiate that this is the case. If advanced practice nurses are to continue to claim that they practice somewhat differently from physicians and bring a value added dimension to primary care, it is essential that the extent of differentiation in practice begin to be documented. The purpose of this study is to examine the extent to which NP's and MD's differ in the processes they employ in managing diabetic adults in the primary care setting. Description of Sample. The sample was comprised of the 98 diabetic patients who had been recruited for a larger randomized study comparing NP and MD patient outcomes. Potential subjects were referred from emergency and urgent care centers and were enrolled only if they reported no regular source of primary care and were willing to be randomized to either an independent NP primary care clinic or one of four MD-run primary care clinics in an urban academic medical center. The sample was 92.8% Hispanic and 67.3% female, and 51% also reported a diagnosis of hypertension. Method. Data were obtained through chart audits conducted by research nurses on site in the five clinics. The review was carried out according to a standardized format and included chart entries during the first 6 months of enrollment in the practice. The data collection instrument required the chart reviewer to indicate (yes/no) whether the record included evidence of specific monitoring, screening, referral, and patient education behaviors that were derived from standards for diabetes management. Inter-rater reliability was checked periodically throughout the chart review. NP-MD comparisons were analyzed using Chi Square (SPSS). Results. Chart audits revealed that NP's exhibited more frequent monitoring behaviors than MD's, specifically urinalysis (79.7% vs 56%) and serum glucose monitoring (71.2% vs 51.3%). Physicians were more likely to refer patients to an ophthalmologist (56.4% vs 35.6% for NPs). NPs were more likely than MDs to chart that they provided general diabetes education, including nutrition, exercise, foot care, and medications (72.9% vs 38.5%). Conclusions. This study provided preliminary evidence that it is possible to quantify differentiated practice using data from chart audits. Admittedly a major limitation is that the audits reflect only those behaviors that are documented by the provider. However, the audit indicated that NPs documented more screening and education behaviors, and MDs documented more specialty referrals. The differences in preventive screening and education are consistent with the strong emphasis on prevention and education in nursing.</td></tr></table>en_GB
dc.date.available2011-10-26T20:37:51Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:37:51Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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