Lacking medical knowledge has been identified as an important barrier towards an increased involvement of practice nurse in medical care.
Especially, chronic diseases with frequent consultations and less change in therapy could be possible domains where an increased involvement of practice nurses decreases GPs' workload and increases patient satisfaction [ 5].
At the same time, we argue that contextual factors, such as top-level endorsement, the necessity to comply with a performance measurement system, and the varying involvement of practice nurses produce tensions that can have both an enabling and constraining effect on the process of facilitation.
The resulting classifications informed a cost-effectiveness analysis of alternative levels of involvement of practice nurses in the care of patients with depression in an Australian primary health care setting.
However, the implementation of the CCM requires a team approach, i.e. heightened involvement of practice nurses in patient care.
We chose a qualitative approach because little is known about involvement of practice nurses in the care of chronically ill patients.
Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders.
Involvement of practice nurses were considered reasonable in advice giving and life style counselling.
Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement.
The involvement of practice managers and other members of the practice supervision team in professional development activities would appear prudent in this context.
