Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care

Abstract

Objectives: To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients.

Methods: Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group).

Results: After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p≤5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p≤5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group.

Conclusions: This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities.