Tuesday, 6 December 2011

Care of chronic diseases is moving out of hospitals – but are patients happy with this?

Joan is a patient with diabetes who has been managed by the Diabetes Consultant at the hospital for many years. She has confidence in knowing that she is seen by a specialist. Then she is told that her care can be as well managed by her GP surgery. When she turns up at the surgery she finds that it is the Practice Nurse who will be mainly managing her care now. Joan frets that the standard of care may not be so good as she is no longer being seen by a “specialist”.

Primary care led diabetes management reflects a move of chronic disease care away from the hospital setting, and is seen as the most appropriate way of managing stable long term conditions. However, a paper recently published by myself and colleagues in the International Journal of Nursing Studies explores the response of patients to care being moved out of hospitals. We found that patients were more at ease with their chronic disease being managed by the hospital which they regarded as having specialist expertise in a particular chronic disease. When asked how they would feel if their care was to be managed mostly by a primary care based nurse who had received extra training in that condition, the response was commonly one of mistrust, but they would go onto say that it was probably more because they were just simply used to seeing a consultant.

There appears to be a fundamental issue with patients’ assumptions about who is competent and appropriate to review their condition. It seems that many of the public are not aware of the significant steps nursing has taken in advancing their competencies in chronic disease management. For example,  the majority of nurses working in this area are independent prescribers following extensive training. We suggest there is a need to increase public awareness about what to expect in the management of their condition and the qualifications and experience of those practitioners they are likely to encounter.

Dr Patricia Wilson is the Research Lead for Patient Experience & Public Involvement at the University of Hertfordshire's Centre for Research in Primary & Community Care.

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