The benefit of a geriatric nurse practitioner in a multidisciplinary diagnostic service for people with cognitive disorders

BMC Res Notes. 2015 Jun 4;8:217. doi: 10.1186/s13104-015-1189-6.

Abstract

Background: The aim of the study was to evaluate whether adding a geriatric nurse practitioner (GNP) to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders (Diagnostic Observation Center for PsychoGeriatry, DOC-PG) could improve quality of care. DOC-PG combines hospital diagnostics and care assessment from a community mental health team and provides the general practitioner (GP) with advice for treatment and management. In a previous study, we found that 28.7% of the advice made by this service was not followed up on by the GP.

Methods: Two cohorts were studied: a group of patients with added GNP (n = 114) and a historical reference sample (n = 137). Both groups followed the same diagnostic protocol and care approach, but, in the GNP group, a care coordinator was added in order to communicate the advice from the DOC-PG to the GP. The primary outcome was the concordance rate of GPs regarding the advice. At the patient level, health-related quality of life (HRQoL) was assessed. Self-Rated Burden and care-related quality of life were measured at the informal caregiver level. Measures were conducted immediately after DOC-PG diagnosis and after 6 and 12 months. Univariate analyses, logistic regression analyses, and mixed model multilevel analyses were used to test differences between both groups.

Results: Total concordance rates were significantly higher in the GNP group compared to the reference sample (82.1 and 71.3%, respectively; p < 0.001). No improvement in patient HRQoL was identified. Among the informal caregivers, a significant reduction of Self-Rated Burden was found in the GNP group at 12 months (adjusted mean difference -1.724, 95% CI -2.582 to -0.866; p < 0.001).

Conclusions: Adding a GNP to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders may improve the GP concordance rate of the advice from the DOC-PG and reduce subjective burden of the informal caregiver.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / organization & administration
  • Attitude of Health Personnel
  • Chi-Square Distribution
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / nursing*
  • Cognition Disorders / psychology
  • Cognition*
  • Communication
  • Community Health Services / organization & administration*
  • Cooperative Behavior
  • Female
  • General Practitioners / organization & administration
  • Geriatric Assessment*
  • Geriatric Nursing / organization & administration*
  • Health Services for the Aged / organization & administration*
  • Humans
  • Interdisciplinary Communication
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Nurse Practitioners / organization & administration*
  • Patient Care Team / organization & administration*
  • Predictive Value of Tests
  • Prognosis
  • Quality of Life
  • Surveys and Questionnaires