Addressing chronic and complex conditions: what evidence is there regarding the role primary healthcare nurses can play?

Abstract

Primary healthcare services in Australia need to respond to the needs of an ageing population and the rising prevalence of chronic and complex conditions in that population. This paper reports on the results of a comprehensive Australian and international literature review on nurse-led and nurse-involved primary healthcare interventions with a particular focus on those serving people with chronic and complex conditions and hard to reach populations. The key question this review addresses is: what role can nurses play in primary healthcare to manage people with chronic and complex conditions? International evidence demonstrates that nurses working in primary care provide effective care, have high patient satisfaction and patients are more likely to comply with nurse instructions than general practitioner instructions. Nurses can provide care equivalent to doctors within their scope of practice but have longer consultations. Lifestyle interventions provided by nurses have been shown to be effective for cardiac care, diabetes care, smoking cessation and obesity. The nursing workforce can provide appropriate, cost-effective and high-quality primary healthcare within their scope of practice. What is known about the topic? The prevalence of chronic disease worldwide is increasing due to our lifestyles and ageing populations combined with our extended lifespans. People living in rural and remote areas have higher rates of disease and injury, and poorer access to healthcare. In particular, many older people suffer multiple chronic and complex conditions that require significant clinical management. Nurses are playing increasingly important roles in the delivery of primary healthcare worldwide and international evidence demonstrates that nurses can provide equivalent care to doctors within their scope of practice but have longer consultations. What does this paper add? There is clear international evidence that nurses can play a more significant role in supporting preventive activities and addressing the needs of an ageing population with chronic and complex conditions. In contrast with earlier evidence, recent evidence suggests that nurses may provide the most cost-effective care. What are the implications for practitioners? Adequately prepared nurses can provide a range of effective and cost-effective primary healthcare services in chronic disease management. Studies report that patients are satisfied with nursing care. Nurses should be utilised to their full scope of practice to provide ongoing care to these populations.