Effective nurse-led chronic care: Dr. Margaret Horsburgh
Dr. Margaret Horsburgh is Associate Professor of Nursing at the University of Auckland, Faculty of Medical and Health Sciences. She is a Registered Nurse and a Registered Midwife with work experience both in New Zealand and the United Kingdom She is currently establishing a nursing base in the School of Population Health at the University of Auckland, with a project supporting the development of nurse-led services in primary health care. The project has the goal of reducing cardiovascular disease risk in populations. (For more information on the project being led by the School of Population Health follow the link above.)
Q: How would you like to see the role of nurses in “I would like to see nurses having more opportunities to put in place chronic care management programmes in the community. My take is that at the moment the situation is hugely variable. There are some absolutely fantastic things happening, where nurses have actually set up nurse clinics and are really managing patients, and yet there are other areas where people don’t even know where to begin. “My vision is of a team of nurses, with a lead nurse who would also prescribe and adjust medications linked with a multidisciplinary team.” Q: What do you see as the current barriers preventing this vision? “Another huge barrier is funding. There’s a lack of understanding about how current funding works. The barrier is not that nurses are paid by GPs – the barrier is understanding how you might make funding work. However, there is no doubt that changes to some of our funding arrangements would make a huge difference. “There is not enough leadership for nurses in individual practices, and providing this can make a big difference. An example of effective leadership is the work being done by Gabrielle Gallagher (a practice nurse employed by ProCare Health Ltd as a Clinical Support Facilitator). Gabrielle runs a CVD risk assessment and management nurse clinic within general practice. She also visits other clinics within the Auckland area to demonstrate PREDICT 2 (an electronic decision support tool) and discusses with practice teams how a systematic approach to screening may be achieved, with the contribution of the practice nurse. She spends three months with a clinic, supporting the set up and implementation of programmes. The support Gabrielle provides is so valued, that many clinics report that would like to hire a nurse to fill the gap left after her departure. “Finally, there hasn’t been enough education for primary healthcare nurses in this whole area – although this is now beginning to improve.
chronic care management evolve?
“The biggest barrier I see is lack of teamwork, and a lack of understanding of what teamwork really means. One thing we’ve found in the work we’ve been doing that makes a huge difference to nurse’s confidence is when GPs start to share cases with nurses. GP confidence in the nurse, and the nurse’s confidence in their own abilities escalates when this sharing happens. It’s commonsense, but GPs may not talk about cases with their own GP colleagues, let alone involve nurses.
“Teamwork, leadership, understanding funding and education – these are critical to the success of nurse-led chronic care programmes.”
One Further Test Article