In Australia for instance, primary care-based funding initiatives have been implemented
to encourage general practices to employ practice nurses. The aim of this paper is to discuss
limitations of the current funding and policy arrangements in enhancing the clinical role of
practice nurses in the management of chronic conditions. A research study from a real-world
economic evaluation, the Primary Care Services Improvement Project (PCSIP) linked routinely
collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of
increased practice nurse involvement in clinical-based activities for the management of diabetes
and obesity. The findings suggested that the active involvement of practice nurses in
collaborative clinical-based activities is cost-effective, as well as addressing general practice
workforce issues. Although primary healthcare organizations can play a key role in supporting
enhanced practice nurse roles, improvements to practice nurse funding models could further
encourage more efficient use of an important resource.
A risk-adjusted cost-effectiveness analysis of alternative models of care for the
management of diabetes patients. These models were based on the reported level of involvement
of practice nurses in the provision of clinical-based activities. Potential confounders were
controlled for by using propensity score-weighted regression analyses (Afzali, et al., 2013). The
impact of alternative models of care on outcomes and costs was measured and incremental cost-
effectiveness estimated. Evidently, the high-level model is a cost-effective way of managing
diabetes patients. Our findings highlight the need for effective incentives to encourage general
practices to better integrate practice nurses in the provision of clinical services.
New data from nursing evaluations show the potential role for nurses in a reconfigured,
collaborative health care system. Studies have identified the practice of nursing as a largely
unexplored resource (Halcomb, et al., 2004). Major themes stand out from many reviews
including: (1) current general practice services face significant barriers to the implementation of
evidence-based HF practice; (2) there is considerable variation in the practice nurse role between
general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4)
multidisciplinary interventions can effectively deliver secondary prevention strategies; (5)
practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice
nurses are favorably perceived by consumers although there is some confusion about the nature
of their role.