Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review
Section snippets
What is already known about the topic?
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Previous systematic reviews showed the effects of nurse-led care were comparable to physician-led care in several settings.
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However, majority of these systematic reviews focussed on single specialty settings, were conducted over 10 years ago, and did not provide a detailed synthesis of economic and process outcomes.
What this paper adds
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This paper provides an updated systematic review of the literature, confirming that nurse-led care produce equivalent or better outcomes compared to physician-led/standard care in managing chronic conditions in the ambulatory care setting.
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This paper also suggests a number of important process outcomes such as education and qualification of the nurse; self-management support; resources available for the nurse; and prescribing capabilities. These factors should be carefully considered for future
Background
With the increasing burden of chronic and age-related diseases, and the rapidly increasing number of patients receiving ambulatory or outpatient-based care, nurse-led clinics or services have been suggested as one solution to manage increasing demand on the health system as they may reduce waiting times, resources, and costs while maintaining patient safety and enhancing satisfaction (Barkauskas et al., 2011, Bergman et al., 2013). Nurse-led services developed as an advanced practice role for
Aims
The primary aim of this review was to assess the clinical effectiveness of nurse-led services in the ambulatory or community care setting. The secondary aims of this review were to examine the economic outcomes and to characterize the nurse-led services by describing (i) the training and qualification requirements of the nurses; (ii) whether self-management support was a component of the nurse-led intervention; (iii) whether the interventions were delivered by nurse practitioners. These three
Methods
This systematic review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered in PROSPERO (ID 42016036924).
Search results
A total of 2863 titles were identified from the initial search. After removing duplicates and screening titles and abstracts, 60 full text articles were retrieved and assessed for eligibility. Of these 60 articles, 25 studies met the inclusion criteria and were included in this review (Fig. 1, PRISMA flow diagram).
Characteristics of the included studies
The 25 included studies involved 180,308 participants and examined nurse-led services in a wide range of conditions and care settings caring for adult patients with heart failure and
Discussion
To the best of our knowledge, this systematic review is the largest review examining the effects of a nurse-led model of care in the ambulatory setting, including 25 original research studies of 180,308 participants. While several reviews exist in the literature (Schadewaldt and Schultz, 2011, Laurant et al., 2005, Latour et al., 2007), this review specifically focussed on studies that examined models of care where registered nurses have the primary responsibilities of care over the patient’s
Conclusions
Nurse-led care is a safe and feasible model of care for consideration across a number of settings. With appropriate training and support provided, nurse-led care is able to produce at least equivocal outcomes in terms of patient HRQoL, symptom burden, self-management and disease-specific clinical targets compared to physician-led care for managing chronic conditions. The strategic expansion of community-based nurse-led services has the potential to transform chronic illness care, creating a
Acknowledgements
The Office of the Chief Nursing and Midwifery Officer, Division of Clinical Excellence, Queensland Health, Australia provided funding for this project.
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