16 research outputs found
Consultation training of nurses for cardiovascular prevention – A randomized study of 2 years duration
An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study
Reikšminiai žodžiai: Ligų prevencija; Sveikatos stiprinimas; Šeimos gydytojai; Šeimos gydytojų rengimas; Šeimos gydytojų švietimo poreikiai; Disease prevention; Family physicians; Family physicians educational needs; Health promotion; Training of family physician
Primary care nurses: effects on secondary care referrals for diabetes
Background: Primary care nurses play an important role in diabetes care, and were introduced in
GP-practice
partly to shift care from hospital to primary care. The aim of this study was to assess whether
the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with
the introduction of primary care nurses, and whether these changes were related to the number of
diabetes-related contacts in a general practice.
Methods: Healthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed
and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that
participated in the Netherlands Information Network of General Practice (LINH). Multilevel
logistic and linear regression analyses were used to analyse the effect of the introduction of
primary care nurses on referrals to internists, ophthalmologists and cardiologists and
diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known
T2DM patients.
Results: Referrals to internists for newly diagnosed T2DM patients decreased between 2004 and
2006 (OR:0.44;
95%CI:0.22-0.87) in all practices. For known T2DM patients no overall decrease in referrals to
internists was found, but practices with a primary care nurse had a lower trend (OR:0.59). The
number of diabetes-related contacts did not differ between practices with and without primary care
nurses. Cardiologists’ and ophthalmologists’ referral rate did not change.
Conclusions: The introduction of primary care nurses seems to have led to a shift of care from
internists to primary care for known diabetes patients, while the diabetes-related contact rate
seem to have remained
unchanged.
To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review
Value-based healthcare in ischemic stroke care: case-mix adjustment models for clinical and patient-reported outcomes
Improvement of shared decision making in integrated stroke care: a before and after evaluation using a questionnaire survey
Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis
BACKGROUND: Physicians' shortage in many countries and demands of high-quality and affordable care make physician-nurse substitution an appealing workforce strategy. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the impact of physician-nurse substitution in primary care on clinical parameters.
METHODS: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected peer-reviewed RCTs comparing physician-led care with nurse-led care on changes in clinical parameters. Study selection and data extraction were performed in duplicate by independent reviewers. We assessed the individual study risk of bias; calculated the study-specific and pooled relative risks (RR) or weighted mean differences (WMD); and performed fixed-effects meta-analyses.
RESULTS: 11 RCTs (N = 30,247) were included; most were from Europe, generally small with higher risk of bias. In all studies, nurses provided care for complex conditions including HIV, hypertension, heart failure, cerebrovascular diseases, diabetes, asthma, Parkinson's disease and incontinence. Meta-analyses showed greater reductions in systolic blood pressure (SBP) in favour of nurse-led care (WMD -4.27 mmHg, 95% CI -6.31 to -2.23) but no statistically significant differences between groups in the reduction of diastolic blood pressure (DBP) (WMD -1.48 mmHg, 95%CI -3.05 to -0.09), total cholesterol (TC) (WMD -0.08 mmol/l, 95%CI -0.22 to 0.07) or glycosylated haemoglobin (WMD 0.12%HbAc1, 95%CI -0.13 to 0.37). Of other 32 clinical parameters identified, less than a fifth favoured nurse-led care while 25 showed no significant differences between groups.
LIMITATIONS: disease-specific interventions from a small selection of healthcare systems, insufficient quantity and quality of studies, many different parameters.
CONCLUSIONS: trained nurses appeared to be better than physicians at lowering SBP but similar at lowering DBP, TC or HbA1c. There is insufficient evidence that nurse-led care leads to better outcomes of other clinical parameters than physician-led care
Substitution of physicians by nurses in primary care: a systematic review and meta-analysis
Background In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. Methods We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. Results 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. Conclusions The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research