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Nurse practitioners can boost quality of care for older patients with chronic conditions
Date:6/26/2013

with both patient symptoms and the management of chronic illnesses that may not have acute symptoms. "There just isn't enough time in the office to do both," Reuben said.

For the current study, researchers screened 1,084 patients at two primary care facilities in Southern California for four chronic geriatric conditions: falls, urinary incontinence, dementia/Alzheimer's disease, and depression. Of those patients, 658 had at least one condition; 485 of the 658 patients were then randomly selected for medical review.

Of those 485 patients, 237 (49 percent) were seen by a nurse practitioner, for co-management with a primary care physician of at least one condition. The rest were seen only by a primary care physician.

The researchers examined whether a set of measures known as "quality indicators" were performed for each condition. For example, if a patient had a history of falls, did the care provider assess whether the patient might be taking medications that increase the risk of falls and assist the patient in reducing or stopping the use of that drug?

The study authors found that the percentage of quality indicators that were satisfied for patients whose cases were co-managed by a nurse practitioner and a physician was higher than for those seen only by a physician.

For falls, 80 percent of quality indicators were satisfied for co-managed cases, compared with 34 percent for physicians alone; for urinary incontinence, 66 percent of indicators were satisfied, compared with 19 percent; for dementia, 59 percent were satisfied, compared with 38 percent; and for depression, 63 percent were satisfied, compared with 60 percent.

Much of the difference was due to the fact that the nurses were likely to take far more detailed patient histories and to perform other assessments. For instance, the pass rates that is, whether the measure was performed for taking a patient's history of falls was 91 percent for co-
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Contact: Enrique Rivero
erivero@mednet.ucla.edu
310-794-2273
University of California - Los Angeles Health Sciences
Source:Eurekalert

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