NICE publishes evidence summaries
January 26, 2013 by admin
NICE has published some more of its new ‘evidence summaries’. These are not formal NICE guidance but critical reviews of the available evidence to aid decision making. In the ‘unlicensed/off-label medicines’ series, NICE has recently published evidence summaries for: Sleep disorders in children and young people with attention deficit hyperactivity disorder: melatonin and Chronic anal fissure: 2% topical diltiazem hydrochloride. In the ‘new medicines’ series, it has looked at aclidinium bromide and glycopyrronium bromide for chronic obstructive pulmonary disease and lixisenatide for Type 2 diabetes.
NICE consults on diabetes and glaucoma draft quality standards
November 10, 2010 by admin
New draft quality standards for diabetes in adults and glaucoma have been published by NICE and comments invited.
Consultations in diabetes care with nurse prescribers: patients’ views
September 20, 2010 by admin
Nurses prescribing for people with diabetes do so using the principles of patient-centred care, to the benefit of their patients, according to the conclusion of this study involving interviews with 41 patients with diabetes from the primary care case loads of seven nurse prescribers. Other benefits, for example improved understanding of treatments and conditions and improved self-care, seemed to result from the combination of a person-centred care approach combined with the additional knowledge and abilities of the nurse prescriber. Patients felt that continuity of relationships, flexibility over consultation length, nurses’ interpersonal skills, and specialist diabetes knowledge were all crucial. The authors argue that a number of related aspects of the nurse consultation style are coming together, enhancing patient care - in ways that may improve treatment decisions and adherence.
The extent to which patients wanted information about treatment options, or wanted to be involved in the decisions, varied widely and they were largely happy with the extent of their involvement. The provision of information about possible side effects seemed to be an area of inconsistency, however.
Stenner KL, Courtenay M and Carey N. Consultations between nurse prescribers and patients with diabetes in primary care: a qualitative study of patient views. Int J Nurs Stud 2010; in press. doi:10.1016/j.ijnurstu.2010.06.006.
Patients ‘confident’ about nurse prescribing
June 25, 2010 by admin
In diabetes care, patients were confident about nurse prescribing and reported improved access to medicines and greater efficiency, in this interview-based study. The 41 patients with diabetes were under the care of a seven nurse prescribers - some general practice nurses and some diabetes specialist nurses.
Interestingly, the patients were able to demonstrate specific improvements in efficiency and access - for example, being able to get an appointment with a nurse at short notice. Nurses were seen as more flexible than doctors but doctors’ time was also perceived as more important! So, nurse prescribing had contributed to improving the service in ways which patients noticed and cared about.
Patients expected teamwork among health professionals, preferring to see doctors for conditions perceived to be more serious or undiagnosed, and expected nurses to have had the necessary training and experience, as well as specialist diabetes knowledge, if they were to prescribe. Confidence in their ability to prescribe was inspired by these attributes and also patients’ direct experience, nurses’ willingness to refer to doctors or others when unsure, good communication skills, and attention to detail.
Patients of the diabetes specialist nurses expected the nurse prescriber to prescribe new medication or equipment but only that related to diabetes. In contrast, some patients of the general practice nurses saw the role as monitoring and continuing to prescribe medication initiated by the doctor although others were happy for the nurse to prescribe medicines for co-morbidities - there was a varied range of views among these general practice patients.
The authors conclude that workforce planners need to include services provided by nurse prescribers alongside those of doctors.
NHS Diabetes publishes new guidelines
April 29, 2010 by admin
NHS Diabetes has published new guidelines for downloading on topics such as hospital management of hypoglycaemia in adults and self-monitoring of blood glucose in people with Type 2 diabetes not treated with insulin.
New SIGN diabetes management guideline published
March 26, 2010 by admin
An updated guideline for the management of diabetes has been launched by the Scottish Intercollegiate Guidelines Network (SIGN). There is a quick reference guide too, and a guide for patients and carers.
Implementation of nurse prescribing in diabetes
March 11, 2010 by admin
‘Few current problems’ were reported by nurses prescribing for patients with diabetes and their colleagues in this case study, and initial implementation problems had been resolved. Diabetes services were ‘primed’ to assimilate nurse prescribing.
The interviews, with nurse prescribers, administrative staff, physicians and non-prescribing nurses, revealed some interesting findings. Discontinuing the extended formulary in 2006 had ‘a profound effect’: because these nurses could now prescribe insulin and oral hypoglycaemic agents independently, the preferred mode switched from supplementary to independent prescribing. This allowed nurses to make better use of their prescribing qualification. The authors suggest that supplementary prescribing may be less useful in the management of long-term conditions than was originally thought.
In this case study, prescribing was found to fit into pre-existing structures, which meant that it could be seen as improving efficiency without requiring major changes - this may have smoothed the road to implementation. Success also depends on organizational support, good relationships between professionals, and acceptance of the prescribing role.Â
Diabetes care enhanced by nurse prescribing
February 4, 2010 by admin
This case study of nurse prescribers caring for people with diabetes found that the care they provided was enhanced by prescribing and that their prescribing and communication skills integrated well.
The evidence and analysis from interviews, patient questionnaires and videotaped consultations highlighted their good communication skills - particularly empathy and listening. The consultations included clear exchanges of information about medicines management and self-care. These aspects of care are particularly important to people with diabetes. The process was also seen as more efficient by nurses, and the patients reported good access and short waiting times.
The nurse prescribers were less consistent about explaining the risks and benefits of treatments and their side effects, a concern which has been noted before, although it is always difficult to know what had been said in previous consultations. In addition, although prescribing by nurses was seen as conferring some safety benefits (for example, that doctors were not signing prescriptions for patients they had not seen), the nurses did not consistently explore the use of non-prescribed herbal or over-the-counter medicines.
Courtenay M, Stenner K and Carey N. An exploration of the practices of nurse prescribers who care for people with diabetes: a case study. J Nursing Healthcare Chronic Illness 2009; 1(4): 311-320.
NICE proposes new QOF indicators for diabetes, epilepsy, learning disability
August 14, 2009 by admin
On 10 August, NICE published its first recommendations for changes to the Quality and Outcomes Framework (QOF), listing potential new indicators for epilepsy, diabetes and learning disability in its ‘menu’. The menu can be found here and recommendations for indicators that could be retired here.
These are the first potential indicators to be produced since NICE took over the process in April this year. These indicators will be discussed in negotiations between NHS Employers and the British Medical Association about the QOF for 2010/2011.
Diabetes Type 2 guidance adds new treatment options
June 6, 2009 by admin
The DPP-4 inhibitors - sitagliptin and vildagliptin - should be considered for patients on metformin with inadequate blood glucose control for whom adding sulfonylurea is not appropriate. This is one of the new recommendations issued by NICE, in its short clinical guideline ‘Type 2 diabetes: newer agents’, at the end of May.
NICE says the guideline increases the treatment options for blood glucose control in patients with Type 2 diabetes and is a partial update of last year’s clinical guideline update. Other recommendations tackle insulin therapy (including long-acting insulin analogues), and the use of exenatide and the thiazolidinediones. NICE has estimated that the cost of implementing these recommendations will be £27,288,000 annually in England.
The chair of the guideline development group, consultant physician Amanda Adler, said that the guidelines, “acknowledge that the treatment of type 2 diabetes may require many drugs, often used simultaneously”.
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