We read the paper of Voogdt-Pruis et al1 with interest, since we have recently reviewed the literature for nurse interventions in primary care management of hypertension. We would like to offer the following observations:
Firstly, although no previous study has reported from the Netherlands there have been reports of similar studies from Scotland,2,3 and England.4,5 Three of these demonstrated improvements in blood pressure control with nurse-led interventions,2,3,5 while the other did not.4
The authors1 conclude that their findings support the involvement of practice nurses in cardiovascular risk management. This is based on the demonstration mainly of non-inferior outcomes; however, this can only be justified by inclusion of formal cost effectiveness analysis. Few previous studies of nurse-led care in hypertension have reported cost data, and those UK studies that have done found higher costs associated with nurse involvement, due to increased time spent offsetting the expected savings on salary costs.6,7 Therefore, further studies must be undertaken that include formal economic evaluation and determine whether the increased cost of nurse-led interventions represents good value for money in terms of improvements in patient health outcomes.
- © British Journal of General Practice, 2010.
