Comparison of Prescribing and Non-prescribing Nurses in the Management of People with Diabetes in English General Practice

Aim: To compare nurse prescribers and non-prescribers managing people with diabetes in English general practice regarding: a) characteristics of patients, b) activities and processes of care, c) patient outcomes (self-management, clinical indicators, satisfaction), d) resource implications and costs Background: Over 35,000 nurses in United Kingdom are able to prescribe the same medicines as doctors provided that it is within their level of experience and competence. Over 30% of them, mostly in general practice, prescribe medicines for patients with diabetes. Design: A comparative case study. Method: Nurses managing care of people with diabetes were recruited in twelve general practices in England; six had prescribing capability, six did not. Patients, recruited by nurses, were followed for six months (2011-2012). Results: The patient sample comprised 131 in nurse prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed, and cared for by the nurse longer than those of nonprescribers. There were no differences in reported self-care activities or HbA1c test results, between the patients of the two types of nurse; the mean HbA1c decreased significantly in both groups. Patients of prescribers were more satisfied. Consultations frequency was similar, but duration was longer for prescribers (by average of 7.7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher grade/ salary band than non-prescribers. Conclusion: Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients, and longer consultations, possibly contributing to higher satisfaction with their care. Employment costs of prescribing nurses are likely to be higher. 250 words