Independent Nurse Practitioners Can Lead the Way to Better Heart and Diabetes Care
Everything we recommend on this platform is an evidence-based approach consistent with best practices. Chronic diseases like heart disease, diabetes, and mental illness generate 90% of American healthcare costs but we have no organized primary care approach to this problem. These conditions are all related. We have primary care hospitalists and urgent care teams to address a specific collection of medical problems, but we don’t have chronic condition teams. That is a major gap in our medical system and it makes absolutely no sense.
Nurse practitioners are uniquely qualified to begin to fill this gap right away. Please read this link carfully. It is the most important quality improvement article in all medical literature. There are many things that make sense in quality improvement that simply don’t work but this lesson is so hard to learn. This is especially true in chronic diseases like heart disease. The main task in treating heart disease and diabetes is achieving aggressive goals for blood pressure, sugar, and cholesterol by using lifestyle measures and medications that precisely interfere with the biology causing the disease in the first place.
Performance in addressing these issues in the United States is terrible. Only 44% of patients with high blood pressure have a blood pressure of 140/90 or less. Performance on the other risk factors is equally poor. Optimal medical therapy (OMT) for diabetes is defined by achieving similar goals for blood pressure, sugar, and cholesterol while not smoking or taking an aspirin. Fewer than one in five diabetics achieve OMT. Moving those numbers with best practice interventions is the key to better health at lower cost in these conditions. Here is the critical insight:
“The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms. In randomized clinical trials, A1C levels fell threefold more in 1,969 patients followed by nurses and pharmacists compared with 1,573 patients under usual care. Several nonglycemic outcome measures also significantly improved with nurse- or pharmacist-directed diabetes care compared with usual care. These included LDL cholesterol, triglycerides, and systolic and diastolic blood pressure. These impressive results stand in contrast to case management in which nurses do not have prescriptive authority”
This is powerful evidence that primary care teams focused on a related set of chronic diseases are the way forward. Case management, healthcare navigation, care pathways, and systems approaches are core nurse competencies. In the green states in the map above, nurse practitioners can start these teams independently. Nurse practitioners, pharmacists, and physician assistants play an indispensible role and we can get started now. We have the systems to support these teams including protocols and the information infrastructure to support providing and measuring care processes and outcomes. We can train your team members for this important work and we are eager to work with you.
Teams like this have existed in other countries for 15 years. Wide availability of OMT is a reality there. Please help us understand how we can bring these important benefits to all Americans more quickly. 423-782-0372 wbestermann@congruityhealth.com