There are 70,942 people with diabetes in Haifa- Galil District of Clalit Health services, most are treated in primary care clinics. 10.7% have an HbA1c above 9% and 14.7% of the Arab patients. The HMO is in a process of reallocating and redistributing personnel to better meet the needs. The nursing staff and specifically the graduates of the advanced diabetes course (GADC) are an important asset that needs to be maximally utilized to meet this end. There are 24 nurses who are GADC, 19 work in primary care setting.

Aims: Improvement of metabolic control by enhancing intervention by the GADC. Positioning the role of the GADC in primary care clinics.

Methods: Initiating a quality forum for the graduates led by the diabetes nurse specialist (DNS) coordinator and the head of nursing services to launch a targeted plan of intervention in the 18 community clinics in which they work. The 19 nurses make the intervention in their clinics - 7,800 patient with diabetes in total: invite them for assessment of adherence to therapy, patient education, intensification of therapy and follow-up until getting to target. Support, empowerment, supervision and ongoing assessment of the process by the District DNS.

Results: Improvement in the implementation of performance measures in the clinic from 81.7 to 88.4 (6.6) % in the total population and from 74.9 to 83.5 (8.6) % in the Arab sector. Improvement in the overall metabolic control from 77.9 to 86 (8) % and from 68.9 to 79 (10.1) % respectively. Decrease in HbA1c in those above 9% by -2.3% and -3.3% respectively.

Conclusions: A DNS led structured intervention by GADC as part of the policy of the District nursing administration, maximizes their abilities and professional authority of the graduates. The knowledge and skills provided by the GADC significantly improves performance measures as well as metabolic control. Continue the integration of future graduates into the framework at the community clinic level.


O. Waizinger: None.

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