BURDEN OF CARDIOVASCULAR DISEASE AND ACHIEVING EVIDENCE-BASED PRACTICE
Cardiovascular disease (CVD) is increasingly recognised as an important health concern (Australian Institute of Health and Welfare (AIHW) 2004). The economic and social burden of CVD has a significant impact on individuals, their families and the community. In 2001, one in five Australians had CVD, with 1.1 million disabled as a result (AIHW 2004).
Although many evidence-based CVD guidelines exist (National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand 2004), the implementation of these into usual care represents considerable challenges, particularly in general practice (Fuat, Hungin & Murphy 2003; Grol & Grimshaw 2003; Phillips, Marton & Tofler 2004). However, in order to moderate short and long term treatment goals, CVD management must extend into community settings (Krum 1997). Historically, the focus of Australia's health system has been on acute, episodic management, rather than on integrated systems of care (New South Wales Department of Health 2005). Yet it is the integration of a range of services from multiple care providers that is critical to best meet the needs of the chronically ill (New South Wales Department of Health 2005).
MODELS OF CARE TO IMPROVE CVD OUTCOMES
To date, the literature has primarily focussed on acute care based models of nurse-led service delivery in CVD (McAlister et al. 2001; Page, Lockwood & Conroy-Hiller 2005). These interventions only address a subset of the population often in the later stages of the illness course and are potentially not efficacious or effective in all settings. To effect significant improvements in health outcomes, future interventions need to consider novel methods of consumer engagement at all stages of the illness trajectory. Given their position within the familiar and accessible environment of general practice and the potential for prolonged engagement with the individual consumer, the practice nurse represents a potentially useful adjunct to current models of CVD management (Halcomb et al. 2004).
PRACTICE NURSING IN AUSTRALIA
Practice nursing in Australia has reached a critical point at which decisions must be made regarding professional development, policy, research and scholarship (Halcomb, Patterson & Davidson 2006). Significant developments have occurred in the development of practice nursing in recent years. Advancements include debate in the peer reviewed literature relating to the general practice nurse role and the management of chronic disease (Australian Medical Association Council of General Practitioners 2005; Bartels & Burke 2004; Hegney et al. 2004a; Hegney et al. 2004b; Infante et al. 2004; Laurant et al. 2005; Meadley 2004; Meadley, Conway & McMillan 2004; New South Wales Department of Health 2005; Pilotto et al. 2004; Royal College of General Practitioners 2004; Royal College of Nursing 2004; Watts et al. 2004); changes to general practice funding, including the introduction of item numbers for the delivery of specific services by general practice nurses; and Commonwealth funding for recruitment of additional general practice nurses (Halcomb et al. 2006). However, initiatives to develop and promote the Australian practice nurse role have, to date, been reactive and driven by a diversity of stakeholders within the healthcare system and lack a coordinated, strategic approach. Clearly, multiple stakeholders and diverse expectations require strategic role development to minimise role conflict and ambiguity (McKenna, Keeney & Bradley 2003). In order to debate and discuss the development of the practice nurse role, a consensus conference was conducted to:
* Explore the experiences of clinical and academic experts in the current general practice management of CVD;
* Clarify and scope the potential role of the practice nurse in CVD management through the identification of potential elements for novel models of care;
* Identify priority issues in addressing the barriers to the practice nurse role in CVD management. …