Effective pharmacological treatment of painful diabetic neuropathy by nurse practitioners: results of an algorithm-based experience.

OBJECTIVE: To improve the care of patients with painful diabetic polyneuropathy (PDP) by a specialized outpatient clinic for individuals referred by general practitioners and to determine the effects on pain, quality of life, and patient satisfaction. MATERIAL AND METHODS: One hundred twenty-one patients were prospectively enrolled. At baseline and after 12 months at end of treatment, patients filled in a set of validated questionnaires on severity and interference of pain, quality of life, anxiety and depression, and patient satisfaction with the service offered. SETTING: The outpatient clinic is part of a regional chronic care management program, which includes both hospital-based endocrinologists and general practitioners. RESULTS: Twenty-eight patients (27%) did not need any further treatment after one visit to the outpatient clinic. As initial drug, pregabalin was the most commonly prescribed drug (65%); amitriptyline was prescribed in only 30% due to its contraindications. Improvements were found in all pain scores (P < 0.05). Pain interference was improved in sleep (P < 0.01), general activity, and mood (P < 0.05). More than half of the patients (65%) were satisfied with the treatment and wished no further medication changes; 52% had a treatment success defined as pain relief ≥ 30%. Medication was stopped due to inefficacy in 9% of patients and changed due to adverse effects in 20% of the patients. CONCLUSIONS: A specialized outpatient clinic for patients with PDP is an effective health care service. Using diagnostic instruments and a defined treatment algorithm, significant pain reduction was achieved in the majority of patients in a relative short period of time.

The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up.

AIMS: To evaluate the cost-effectiveness of an intervention substituting physicians with nurse specialists. BACKGROUND: Increasing populations of people with diabetes in most Western countries require creative solutions that give high-quality chronic care while controlling costs. Instigating nurse specialists as a substitute for physicians yields positive results in this area. Research about such interventions in a hospital-based setting is limited. METHODS: This paper is a report of a study of a randomized, non-blinded clinical trial including people with diabetes mellitus types 1 and 2. In the intervention group nurse specialists were the central carers, providing care that conformed to a preset protocol. Patients were included between 2004 and 2007. Costs, quality of life and adverse events were measured, cost-effect ratios and incremental cost-effect ratios were calculated based on health-resource utilization rates, corresponding market prices and national tariffs from 2007. RESULTS: Health related quality of life scores did not differ significantly between the control and the intervention group. In the intervention group, fewer patients were hospitalized and fewer side effects from drugs were reported compared to controls. Nurse specialists as central care givers generated a modest reduction in costs per quality adjusted life year gained compared to usual care. CONCLUSION: Nurse specialists give diabetes care that is similar to care provided by physicians in terms of quality of life and economic value. Instigating a nurse specialist as central carer yields opportunities to generate cost savings. Developing interventions which also focus on prevention of complications is recommended when aiming for long-term organisational cost savings.