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