nurse led clinics opportunity for nurses to make a difference wilma scholte op reimer, rn, phd...
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Nurse Led Clinics
Opportunity for nurses to make a difference
Wilma Scholte op Reimer, RN, PhD
Amsterdam School of Health Professions
Academic Medical Center / University of Applied Sciences Amsterdam
Health Care Challenges
Europe is ageing rapidly
Proportion of 65+ years of age
5
10
15
20
1980 1985 1990 1995 2000 2005
0
10
15
20
% 65+
▬ European Region▬ EU-10
▬ European Union▬ EU-15
▬ CIS
║
1980 1985 1990 1995 2000 2005 2010
159
141822273135404448535761667074798388
Age pyramid for Europe in 2008Age
Men Women
4 3 2 1 0 1 2 3 4
Numbers per million
90+
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
159
141822273135404448535761667074798388
Age pyramid for Europe in 2050Age
Men Women
4 3 2 1 0 1 2 3 4
Numbers per million
90+
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
↑ Age = ↑ Disease burden
Major causes of death by age
0%
20%
40%
60%
80%
100%
Cardiovascular diseases Respiratory diseases Digestive disease
Cancer External causes of injury Other
0 10 20 30 40 50 60 70 80 ≥90 TotalAGE
Increasing number of hospital discharges
Hospital Discharge Cardiovascular Disease
1000
1500
2000
2500
3000
3500
1990 1995 2000 2005
No / 1,000 inhabitants
▬ European Region
▬ EU-10
▬ European Union
▬ EU-15
▬ CIS
0
25
35
20
30
15
║
1990 1995 2000 2005 2010
Length of Hospital Stay
6
8
10
12
14
16
18
1985 1990 1995 2000 2005
Days
▬ European Region
▬ EU-10▬ European Union▬ EU-15
▬ CIS
0
12
18
10
16
8
║
14
1985 1990 1995 2000 2005 2010
Older patients often suffer from comorbidity
Underlying Heart Diseases in AFib
61
31 3025
70
41 40
29
0
20
40
60
80
Hypertension Heart failure CAD Valvular HD
≤ 75 years > 75 years
%%
Number of underlying Heart Diseases
0%
20%
40%
60%
80%
100%
Age ≤ 75 Age > 75
4
3
2
1
0
Increasing number of persons at risk
Prevalence of Diabetes in Adults (Age 20-29)
0
2
4
6
8
10
12
Africa EasternMediterranean
and MiddleEast Region
Europe North America South &CentralAmerica
South-EastAsia
WesternPacific
2003 2025
%%
0
20
40
60
80
100
EA-I EA-II ACS I CR AP DM ACS II PCI
%%
Improved Secondary Prevention since 1995
Antithrombotics
Lipid lowering
Beta-blockers
ACE-I/ARB
Surveys
1995 2005-2006
EUROASPIRE SurveysPharmacological Treatment
89
86
75
93
63
66
49
84
32
54
31
81
0 20 40 60 80 100
Lipid lowering
Beta-blocker
ACE-I/ARB
Antiplatelet
1995-19962000-20012005-2006
%%
EUROASPIRE SurveysLifestyle
29
55
38
18
60
54
33
21
87
55
25
20
0 20 40 60 80 100
Cholesterol > 5mmol/L
Blood pressure >140/90 mmHg
BMI > 30 kg/m2
Smoking
1995-19962000-20012005-2006
%%
Also increasing number of caregivers ?
10 to 146 to 10
2 to 33 to 6
14 to 19No data
NURSES PER 1,000 INHABITANTS
6.8 nurses to 1 physician in Ireland
0.5 nurses to 1 physician in Italy
4.5 nurses to 1 physician in the Netherlands
Our Nurse Led ClinicSatellite Clinic of the Academic Hospital
Borders
Patient care
Education
Research
Crossing borders
Education
Research
Patient care
Crossing borders
Education
Research
Patient care
Evidence Based Care
Multidisciplinary Care
28
Why cardiovascular care?
29
Why cardiovascular care?
• Expertise
• Complex & Multidisciplinary care
• High prevalence
• Facilities available
• Good financial possibilities
RESPONSE Trial: nurse led secondary prevention clinics
RESPONSE Trial - Intervention
• 4 visits in 6 months
• Cardiovascular risk monitoring
• Care coordination
• Medical therapy
• Lifestyle counseling
• Adherence
• Screening diabetes
RESPONSE Trial
RESPONSE 2 TrialShared Decision Making
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