Background
Methods
Study identification
Study inclusion and exclusion criteria
Study selection and quality assessment
Data abstraction
Data synthesis
Results
Study identification
Study and population characteristics
Study | Setting | Population | Nurse group | Physician group | Intervention | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
First author, publication (y) | Location | Design, perioda | Facilities, n | Diagnosis | Nurses (n) | Patients (N) | Mean age (SD), y | Male, % | Phys., (n) | Patients (N) | Mean age (SD), y | Male, % | By | FCA | GDL | 1st C | UV | OC | C, n | FUP, months |
Fairall et al., 2012 [25] | ZA 2 | cRCT2, 2008–2010 | Nurse ART clinic, 31 | HIV/AIDS | 103 | 3029 | 38.0 (8.9) | 30 | nr | 3202 | 38.0 (9.6) | 27 | LN | n | y | n | n | y | >1 | 12–18 |
Fairall et al., 2012 [25] | ZA 1 | cRCT1, 2008–2010 | Nurse ART clinic, 31 | HIV/AIDS | 103 | 5390 | 36.0 (9.6) | 33 | nr | 3862 | 35.0 (9.6) | 31 | LN | n | y | n | n | y | >1 | 12–18 |
Houweling et al., 2011 [27] | NL 3 | RCT, period nr | Practice, 1 | DM2 | 2 | 116 | 67.1 (11.0) | 53 | 5 | 114 | 69.5 (10.6) | 42 | NP | y | y | n | n | y | >1 | 14 |
Andryukhin et al., 2011 [18] | RU 1 | RCT, 2006–2009 | Medical centre practice, 1 | Heart failure with preserved ejection fraction | 10 | 50 | 66.5 (3.2) | 27 | 8 | 50 | 68.0 (4.3) | 34 | NP/LN | n | y | n | n | y | >1 | 6 |
Dierick-van Daele et al., 2009 [24] | NL 2 | RCT, 2006 | Practice, 15, Reference, 5 | Common complaints | 12 | 817 | 42.8 (16.5) | 38 | 50 | 684 | 46.1 (16.6) | 40 | NP+ | n | y | y | n | n | 1 | 0.5 |
Chan et al., 2009 [22] | UK 6 | RCT, 2002–2004 | Nurse clinic, 1 | GORD, moderate gastritis, dyspepsia after direct access gastroscopy | nr | 89 | 50.2 (13.9) | 49 | nr | 86 | 48.4 (12.8) | 49 | NP+ | n | y | n | n | y | >1 | 6 |
Hesselink et al., 2004 [26] | NL 1 | RCT, 1998–2002 | Practice, 12 | Asthma and COPD | 2 | 139 | 49.9 (14.2) | 35 | 14 | 137 | 44.7 (13.6) | 28 | LN | n | y | n | n | y | >1 | 0.5, 12, 24 |
Denver et al., 2003 [23] | UK 5 | RCT, 2000–2001 | Nurse hospital-based hypertension clinic, n = nr | DM2,hypertension, under blood pressure lowering treatment | nr | 60 | 58.1 (13.8) | 57 | nr | 60 | 62.4 (9.1) | 70 | NP+ | n | y | n | n | y | >1 | 6 |
Kernick et al., 2000 [28] | UK 4 | RCT, period nr | Health centre, 1 | Psoriasis and eczema | 1 | 55 | 47.4 (18.4) | 39 | nr | 54 | 51.7 (15.8) | 48 | NP+ | n | y | n | n | y | >1 | 4 |
Kinnersley et al., 2000 [34] | UK 3 | RCT, period nr | Practice, 10 | Diverse conditions | 12 | 1465b | range: 0–>75 | 39 | 10 | 1465b | range: 0–>75 | 42 | NP | n | nr | y | y | n | 1 | 0.5 |
Shum et al., 2000 [32] | UK 2 | RCT, 1998–1999 | Practice, 5 | Acute minor illnesses | 5 | 900 | IQR:26.0 (9.0–41.7) | 40 | 19 | 915 | IQR:29.1 (9.7–44.9) | 40 | NP | n | nr | y | y | n | ≥1 | 0.5 |
UK 1 | RCT, 1995–1996 | Practice, 19 | CHD secondary prevention | 28 | 673 | 65.9 (7.9) | 58 | nr | 670 | 66.3 (8.3) | 58 | NP | n | y | n | n | y | >1 | 12, 48 |
Risk of bias in individual studies
Study | Inclusion and exclusion criteria | Outcome | Sequence generation | Allocation concealment | Blinding | Sample | Attrition, % | Funding | |||
---|---|---|---|---|---|---|---|---|---|---|---|
First author | Location | 1ry | 2ry | calc. | size | ||||||
Fairall et al., 2012 [25] | ZA 2 | ✓ | ✓ | ✓ | A | A |
d
| ✓e | ≥200 | <20 | G |
Fairall et al., 2012 [25] | ZA 1 | ✓ | ✓ | ✓ | A | A |
d
| ✓e | ≥200 | ≥20 | G |
Houweling et al., 2011 [27] | NL 3 | ✓ | ✓ | ✓ | I | A | NP | ✓ | ≥200 | <20 | G |
Andryukhin et al., 2011 [18] | RU 1 | ✓ | U | I |
c
| ✓e | <200 | ≥20 | None | ||
Dierick-van Daele et al., 2009 [24] | NL 2 | ✓ | A | A | NP | ≥200 | ≥20 | G | |||
Chan et al., 2009 [22] | UK 6 | ✓ | A | A |
b
| ✓ | <200 | <20 | nr | ||
Hesselink et al., 2004 [26] | NL 1 |
a
| ✓ | ✓ | U | U |
b
| ✓ | ≥200 | ≥20 | nr |
Denver et al., 2003 [23] | UK 5 |
a
| ✓ | ✓ | I | I | NP | ✓e | <200 | <20 | nr |
Kernick et al., 2000 [28] | UK 4 | ✓ | ✓ | A | U | U | ✓e | <200 | ≥20 | Ind. | |
Kinnersley et al., 2000 [34] | UK 3 | ✓ | ✓ | ✓ | A | A | NP | ✓e | ≥200 | ≥20 | G |
Shum et al., 2000 [32] | UK 2 | ✓ | A | A | NP | ✓e | ≥200 | ≥20 | G | ||
UK 1 | ✓ | A | I |
b
| ✓ | ≥200 | ≥20 | G |
Outcomes
Study | Nurses’ role | Population diagnosis | Outcome | Measurement method/scale | FUP, months | Nurse group | Physician group | Effect estimate | |||
---|---|---|---|---|---|---|---|---|---|---|---|
First author, y | Location | ||||||||||
Binary data |
n
|
N
|
n
|
N
| RR (95 % CI) | ||||||
Heart disease | |||||||||||
Andryukhin et al., 2011 [18] | RU 1 | NP/LN | Heart failure PEF | Positiveb changes in class HF | NYHA | 6 | 18 | 40 | 8 | 35 | 1.97 (0.98 to 3.96) |
UK 1 | NP | CHD secondary prevention | Chest pain | ATyPeS/SF36a | 12 | 232 | 508 | 250 | 498 | 0.91 (0.80 to 1.04) | |
UK 1 | NP | CHD secondary prevention | Chest pain | ATyPeS/SF36 | 48 | 147 | 430 | 129 | 385 | 1.02 (0.84 to 1.24) | |
UK 1 | NP | CHD secondary prevention | Worsening chest pain | ATyPeS/SF36 | 12 | 37 | 519 | 54 | 500 | 0.66 (0.44 to 0.98) | |
UK 1 | NP | CHD secondary prevention | Worsening chest pain | ATyPeS/SF36 | 48 | 44 | 439 | 35 | 395 | 1.13 (0.74 to 1.73) | |
Lung disease | |||||||||||
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | No chronic cough and phlegm production or an improvement | Present/absent | 12 | 43 | 108 | 39 | 85 | 0.87 (0.63 to 1.20) |
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | No chronic cough and phlegm production or an improvement | Present/absent | 24 | 41 | 93 | 33 | 79 | 1.06 (0.75 to 1.49) |
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | No wheezing or an improvement in frequency | Never, ever, most days and night | 12 | 68 | 106 | 51 | 85 | 1.07 (0.85 to 1.34) |
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | No wheezing or an improvement in frequency | Never, ever, most days and night | 24 | 53 | 93 | 37 | 79 | 1.22 (0.91 to 1.63) |
Infectious disease | |||||||||||
Fairall et al., 2012 [25] | ZA 2 | LN | HIV/AIDS | Suppressed viral load in patients receiving ARTd | Viral load | 12–18 | 2156 | 3029 | 2230 | 3202 | 1.02 (0.99 to 1.06) |
Fairall et al., 2012 [25] | ZA 1 | LN | HIV/AIDS | Suppressed viral load in patients starting ARTd | Viral load | 12–18 | 1706 | 2375 | 1062 | 1449 | 0.98 (0.94 to 1.02) |
Diverse, acute and minor conditions | |||||||||||
Shum et al., 2000 [32] | UK 2 | NP | Acute and minor | Same, improved or cured self-reported health status | Murphy | 0.5 | 650 | 672 | 646 | 661 | 0.99 (0.97 to 1.01) |
Kinnersley et al., 2000 [34] | UK 3 | NP | Diverse conditions | Same or improved symptoms (much better, better or unchanged) | Likert-type and single reminders | 0.5 | 472 | 484 | 515 | 529 | 1.00 (0.98 to 1.02) |
Continuous data | Mean (SD) |
N
| Mean (SD) |
N
| WMD (95 % CI) | ||||||
Lung disease | |||||||||||
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | Mean change score in dyspnea | MRCQTc | 12 | 0.00 (1.3) | 115 | 0.10 (1.3) | 94 | −0.10 (−0.45 to 0.25) |
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | Mean change score in dyspnea | MRCQTc | 24 | 0.20 (1.4) | 96 | 0.30 (1.3) | 80 | −0.10 (−0.50 to 0.30) |
Metabolic disease | |||||||||||
Denver et al., 2003 [23] | UK 5 | NP+ | DM2 with hypertension, under BPLT | Mean fall in 10-year CHD risk | Framingham CHD risk score | 6 | −2.33 (3.87) | 59 | −0.33 (2.16) | 56 | −2.00 (−3.14 to −0.86) |
Denver et al., 2003 [23] | UK 5 | NP+ | DM2 with hypertension, under BPLT | Mean fall in 10-year stroke risk | Framingham stroke risk score | 6 | −4.33 (6.0) | 59 | −1.80 (3.53) | 56 | −2.53 (−4.32 to −0.74) |
Digestive disease | |||||||||||
Chan et al., 2009 [22] | UK 6 | NP+ | GORD, moderate gastritis | Mean score, dyspepsia severity | GDSS (Gladys) scoreg | 6 | 4.90 (2.9) | 89 | 7.20 (3.1) | 86 | −2.30 (−3.19 to −1.41) |
Skin disease | |||||||||||
Kernick et al., 2000 [28] | UK 4 | NP+ | Psoriasis/eczema | Mean score for symptoms and severity of skin condition | Self-evaluation clinical scoree | 4 | 7.60 (3.3) | 35 | 8.1 (3.3) | 46 | −0.50 (−1.95 to 0.95) |
Common complaints | |||||||||||
Dierick-van Daele et al., 2009 [24] | NL 2 | NP+ | Common complaints | Mean difference in the degree of burden of illness | LikertQTf | 0.5 | −1.77 (3.18) | 473 | −1.50 (2.63) | 451 | −0.27 (−0.65 to 0.11) |
Dierick-van Daele et al., 2009 [24] | NL 2 | NP+ | Common complaints | Mean difference in the concerns about illness | LikertQTf | 0.5 | −1.51 (3.20) | 476 | −1.40 (2.97) | 450 | −0.11 (−0.51 to 0.29) |
Qualitative data | |||||||||||
Metabolic disease | |||||||||||
Houweling et al., 2011 [27] | NL 3 | NP | DM2 | Perceived burden of DM symptoms and rating of symptom troublesomeness | Type 2 Diabetes Symptom Checklisth | 14 | “significant differences at follow-up for some of the Diabetes Symptom Score dimensions (data not shown). After 14 months, the mean sub-dimension scores for DM symptoms ‘fatigue’ and ‘cognitive distress’ and the total scores were lower in each group, although no difference was observed between the groups.” | ||||
Lung disease | |||||||||||
Hesselink et al., 2004 [26] | NL 1 | LN | Asthma/COPD | Respiratory complaints within two weeks after intervention | Disturbance (present/absent) for >1 day or night | 0.5 | “no significant group differences in the number of days or nights disturbed, OR 0.96 (95 % CI 0.56 to 1.61)” | ||||
Common complaints | |||||||||||
Dierick-van Daele et al., 2009 [24] | NL 2 | NP+ | Common complaints | Complications due to illness | Mean number of days of work absence | 0.5 | “1.11 days (nurse, SD 0.32; physician, SD 0.31) of work absence in average” | ||||
Dierick-van Daele et al., 2009 [24] | NL 2 | NP+ | Common complaints | Complications due illness | Mean number of days of inability for daily activities | 0.5 | “no statistically significant differences between groups; mean days unable for daily activities: nurse-led care 2.53 (SD 2.89), physician-led care 2.69 (SD 2.90)” |