Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views.

摘要

BACKGROUND: There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients' views about their consultations with a nurse prescriber. OBJECTIVE: To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management. DESIGN: A qualitative study involving semi-structured interviews and thematic analysis. SETTING: Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009. PARTICIPANTS: Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers. RESULTS: Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment. CONCLUSIONS: The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses' interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients' requirements.