Self-care behavior change and health services utilization of chronic patients received nurse-led management: Experience of primary care in southwestern China
Jiang Lingjun and Liu Suzhen
CBM Foundation, China
: J Nurs Patient Care
Statement of the Problem: Chronic disease is increasing in prevalence and has become a major public health problem in the world causing high morbidity, mortality and serious economic burden. And it is generally accepted that the primary care in community is the most effective way to control chronic disease. Due to the high prevalence of chronic disease and the shortage of general practitioners, exploration of nurse's role in general practice team has been highlighted and the benefits of nurse-led care in community has been recognized in many countries. In our country nurses play little role in the medical team. Therefore, according to the practical experience in abroad, the present study explored the community nurse-led management care for chronic patients in the context of primary care health services. Method: In this randomized study in southwestern China, a nurse-led chronic disease management which was developed and implemented for 2 years in primary care institutions in two major chronic disease areas, hypertension and type-2 diabetes. This study investigated the effects of nurse-led chronic illness management on self-care behavior change and health care service utilization among these patients. 190 participants (102 with hypertension and 88 with diabetes) were randomly allocated to the study group, while 193 participants (102 with hypertension and 91 with diabetes) were assigned to the control group. The study group received group education and case management in addition while the control group received GP-led usual care including blood pressure (glucose) monitoring, telephone follow-up and home visit only. The primary endpoint to be tested was the patients’ self-care behavior assessed by self-administrated questionnaire. Second endpoints were the changes in patients’ health care services utilization. Data was collected at three time points, the baseline, 1 year after intervention and the terminal assessment after 2 years. Findings: The intervention group had a significant higher self-care behavior score than the control group after 24 months (4.01±0.44 vs. 3.75±0.46, p<0.05) and the analyses showed a significant improvement in self-care behavior score (F=17.981, P=0.000) within the study group from baseline to 24 months (not in control group). Community clinic visit frequency was significantly reduced in the two groups (P<0.05), the experimental group reduced more, with 53.1% patients taking a monthly visit. Hospital outpatient visit rate was obviously reduced in study group (P=0.012). No significant reduce was found in emergency-department visits and hospitalizations. Conclusion: A nurse-led chronic disease management can effectively promote the patients’ self-care behavior and led to a better use of health care services.
Jiang Lingjun has completed her Nursing from Hubei University, China. Her expertise is in evaluation and passion in improving the health and well-being. Currently she is pursuing her graduation in the Department of Nursing, Sichuan University.