Cardiovascular Disease Management: Time to Advance the Practice Nurse Role?

Article excerpt

Abstract

Objective: More than two-thirds of health expenditure is attributable to chronic conditions, of which a significant proportion are related to cardiovascular disease. This paper identifies and explores the factors cited by practice nurses as impacting on the development of their role in cardiovascular disease management.

Methods: Sequential mixed methods design combining postal survey (n=284) and telephone interviews (n=10) with general practice nurses.

Results: The most commonly cited barriers to role extension were legal implications (51.6%), lack of space (30.8%), a belief that the current role is appropriate (29.7%), and general practitioner attitudes (28.7%). The most commonly cited facilitators of role extension were collaboration with the general practitioner (87.6%), access to education and training (65.6%), the opportunity to deliver primary health care (61.0%), a high level of job satisfaction (56.0%) and positive consumer feedback (54.6%).

Conclusions: Australian government policy demonstrates a growing commitment to an extended role for general practice in primary health care and cardiovascular disease management. In spite of these promising initiatives, practice nurses face a range of professional and system barriers to extending their role. By addressing the barriers and enabling features identified in this investigation, there is potential to further develop the Australian practice nurse role in cardiovascular disease management.

Aust Health Rev 2008: 32(1): 44-55

THE INCREASING AGEING population and improved survival from previously fatal conditions has increased the number of people with chronic conditions within our community.1 In particular, cardiovascular disease remains the leading cause of death for Australian adults.1 Of significance, a considerable proportion of the burden of cardiovascular disease is attributable to modifiable risk factors that require tailored behaviour-change strategies.2 Cardiovascular disease management is a system of coordinated care where patient self-management is promoted, with an emphasis on promotion of evidence-based practice within a collaborative, interdisciplinary context. In addition, within this model, there is an emphasis on evaluation, addressing both process and outcome measures. It is evident that acute models of care are unable to meet the increasing burden of chronic illness.3,4 Alternate models need to be explored in terms of cost to the health system, workforce implications and added value to consumers.5,6 In particular, issues related to self-management are a key focus of both state and federal government policy and funding initiatives.7 It is likely that the practice nurse can play a critical role in programs relating to cardiovascular risk factor modification, such as anti-smoking and weight control, as well as medication titration, screening and health assessment.8

Evidence for interdisciplinary disease management programs

Interdisciplinary disease management programs improve processes of care, reduce hospital admissions, enhance quality of life and improve functional status in those with cardiovascular disease.9 Although multidisciplinary input is essential to the success of these programs, many are coordinated by specialist nurses in the acute hospital or outpatient setting.9 The focus of this model of disease management is generally on those who have experienced an exacerbation of symptoms or onset of disease that has prompted hospitalisation or specialist medical intervention. This is significant in that, at this time, individuals may either experience denial in relation to the consequences of not engaging in self-management strategies or not be receptive to changes to lifestyle factors that are essential to the success of these programs.10,11 There are also significant challenges in funding these and other cardiovascular risk reduction programs as a consequence of the delineation of funding responsibilities between state and federal governments. …