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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

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Page 1: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 2: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Health Care Challenges

Page 3: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Europe is ageing rapidly

Page 4: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 5: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 6: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 7: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

↑ Age = ↑ Disease burden

Page 8: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 9: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Increasing number of hospital discharges

Page 10: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 11: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 12: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Older patients often suffer from comorbidity

Page 13: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

%%

Page 14: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Number of underlying Heart Diseases

0%

20%

40%

60%

80%

100%

Age ≤ 75 Age > 75

4

3

2

1

0

Page 15: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Increasing number of persons at risk

Page 16: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

%%

Page 17: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 18: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

%%

Page 19: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

%%

Page 20: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Also increasing number of caregivers ?

Page 21: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

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

Page 22: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Our Nurse Led ClinicSatellite Clinic of the Academic Hospital

Page 23: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Borders

Patient care

Education

Research

Page 24: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Crossing borders

Education

Research

Patient care

Page 25: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Crossing borders

Education

Research

Patient care

Page 26: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Evidence Based Care

Page 27: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

Multidisciplinary Care

Page 28: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

28

Why cardiovascular care?

Page 29: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

29

Why cardiovascular care?

• Expertise

• Complex & Multidisciplinary care

• High prevalence

• Facilities available

• Good financial possibilities

Page 30: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical
Page 31: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

RESPONSE Trial: nurse led secondary prevention clinics

Page 32: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

RESPONSE Trial - Intervention

• 4 visits in 6 months

• Cardiovascular risk monitoring

• Care coordination

• Medical therapy

• Lifestyle counseling

• Adherence

• Screening diabetes

Page 33: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

RESPONSE Trial

Page 34: Nurse Led Clinics Opportunity for nurses to make a difference Wilma Scholte op Reimer, RN, PhD Amsterdam School of Health Professions Academic Medical

RESPONSE 2 TrialShared Decision Making