Background Diabetes is considered an exemplar of the challenges facing health systems including the need to reorganise chronic disease management from acute episodic treatment to planned integrated care. In Ireland, a central pillar of the plan for a national model of integrated diabetes care is the introduction of a number of integrated Diabetes Nurse Specialist (DNS) positions. Our aim was to conduct a systematic review to identify the role of the DNS as part of an improvement strategy and elucidate their involvement in facilitating integrated care.
Methods A systematic search of primary intervention studies involving the DNS to improve diabetes care was conducted using PubMed, Medline, EMBASE, CINAHL and PsycINFO (2000–2014). English language studies, both quantitative and qualitative, were included where the improvement strategy was either DNS led, co-ordinated or delivered. Studies of routine or existing services were excluded. Two authors extracted data on study design, nature of the DNS role and involvement within the diabetes care teams. Studies were synthesised through a qualitative content analysis method using NVivo V.10 software.
Results Eleven studies were eligible for inclusion, most of which were conducted in the Netherlands (n = 5) or the UK (n = 4). Seven domains of responsibility were identified: clinical practice (n = 6), disease control (n = 3), prescribing (n = 4), and guidance on self-care (n = 2), education (n = 5), prevention of complications (n = 3) and a liaison role (n = 4). In two studies, the DNS acted as a link between the hospital team and primary care providers. Referrals, part of the liaison role, involved not only GPs referring patients to the DNS but also the DNS referring patients to other health care professionals. The DNS consulted with the GP only if complications or problems arose with patient care. Few studies reported how the DNS role was integrated within the existing team of care providers.
Discussion The clinical role of the DNS is well-defined through the use of care protocols. However, the liaison role between settings and providers is not as clear. This role needs to be delineated to avoid ambiguity and blurring of professional boundaries and to facilitate other health care professionals drawing on the expertise of the DNS.
- Diabetes nurse specialist
- integrated care
- diabetes mellitus