Table 1 Summary characteristics of participants and interventions of studies included in review
From: Substitution of physicians by nurses in primary care: a systematic review and meta-analysis
Study | Setting | Participants | Nurses’ group | Physicians’ group | Intervention | Outcomes reported | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Location, first author, year | Design, period* | FUP, m | Facilities, n | Included diagnosis | Nurses, n | Patients, N | Mean age (SD), y | Male, % | Phys., n | Patients, N | Mean age (SD), y | Male, % | Nurses’ training/experience | FCA | GDL | PS | QoL | HA | M | C |
ZA 2 | cRCT, 2008-2010. | 18 | Nurse ART clinic, 31. | HIV/AIDS. | 103 | 6415 | 38 (8.9) | 30 | nr | 6479 | 38 (9.63) | 27 | Middle nurse managers trained to assume responsibility for ART and established patients’ eligibility for ART. | no | yes | ✓ | ✓ | |||
Fairall, 2012 [36], cohort 2 | ||||||||||||||||||||
ZA 1 | cRCT, 2008-2010. | 16-18 | Nurse ART clinic, 31. | HIV/AIDS. | 103 | 6159 | 36 (9.6) | 33 | nr | 4923 | 35 (9.63) | 31 | Middle nurse managers trained to assume responsibility for ART and established patients’ eligibility for ART. | no | yes | ✓ | ✓ | |||
Fairall, 2012 [36], cohort 1 | ||||||||||||||||||||
NL 6 | RCT, period nr. | 14 | Practice, 1. | Diabetes Mellitus Type II. | 2 | 116 | 67.1 (11) | 53 | 5 | 114 | 69.5 (10.6) | 42 | Practice nurse with one week training in diabetes mellitus; nurse had no special training in the treatment of diabetes prior to starting trial. | yes | yes | ✓ | ✓ | |||
Houweling, 2011 [30] | ||||||||||||||||||||
NL 5 | RCT, 2006-2008. | 24 | Hospital outpatients, 1; Practice, 18. | Asthma. | nr | 36 | 11.2 (2.9) | 64 | nr | 71 (37§, 34‡) | 11.2 (2.5) §; 10.1 (2.6)‡ | 58 | Asthma nurse. | no | yes | ✓ | ✓ | |||
Kuethe, 2011 [25] | ||||||||||||||||||||
RU 1 | RCT, 2006 -2009. | 6, 18 | Medical centre practice, 1. | Heart Failure with Preserved Ejection Fracture. | 10 | 50 | 66.5 (3.2) | 27 | 8 | 50 | 68 (4.3) | 34 | Nurses with special degree in patient education obtained in a joint course. | no | yes | ✓ | ✓ | ✓ | ||
Andryukhin, 2010 [46] | ||||||||||||||||||||
NL 4 | RCT, 2006-2007. | 12 | Healthcare centre, 6. | CVD, Hypertension, Hypercholesterolemia. | 6 | 808 | 64 (9.0) | 58 | 25 | 818 | 64 (9.0) | 62 | Advance practice nurse already employed to manage patients with asthma, chronic obstructive pulmonary disease, or diabetes. | nr | yes | ✓ | ||||
Voogdt-Pruis, 2010 [16] | ||||||||||||||||||||
NL 3 | RCT, 2006. | 0.5 | Practice, 15; Reference, 5 | Common complaints. | 12 | 817 | 42.8 (16.5) | 38 | 50/17† | 684 | 46.1 (16.6) | 40 | Nurse practitioner with Master degree in Advance Nursing trained in common complaints. | no | yes | ✓ | ✓ | ✓ | ||
Dierick-Van Dale, 2009 [39] | ||||||||||||||||||||
UK 9 | RCT, 2002-2004. | 6 | Nurse clinic, 1 | GORD, moderate Gastritis. | nr | 89 | 50.2 (13.9) | 49 | nr | 86 | 48.4 (12.8) | 49 | Gastrointestinal nurse practitioner. | no | yes | ✓ | ✓ | |||
Chan, 2009 [42] | ||||||||||||||||||||
NL 2 | cRCT, period nr. | 12 | nr. | All forms of incontinence. | 1 | 38 | 51 (13.0) | 0 | 28¶ | 13 | 51 (13.0) | 0 | Registered nurse specialist in incontinence. | no | yes | ✓ | ✓ | |||
Du Moulin, 2007 [37] | ||||||||||||||||||||
US 6 | RCT, period nr. | 6 | Community, 2; PHD, 1. | Diabetes Mellitus. | nr | 95 | 55.7 (13.1) | 32 | 108# | 102 | 57 (11.4) | 35 | Diabetes nurse. | no | yes | ✓ | ||||
Hiss, 2007 [32] | ||||||||||||||||||||
NL 1 | RCT, 2000-2001. | 24 | Practice, 12 | Asthma and COPD. | 2 | 139 | 49.9 (14.2) | 35 | 14 | 137 | 44.7 (13.6) | 28 | GP assistant with pre- and during-trial training to deal with the differences between asthma and COPD. | no | yes | ✓ | ||||
Hesselink, 2004 [33] | ||||||||||||||||||||
UK 8 | RCT, 2000-2001. | 6 | Nurse clinic hospital based. | Diabetes Mellitus Type II pre-diagnosed with Hypertension or in receipt of BPLT. | nr | 60 | 58.1 (13.8) | 57 | nr | 60 | 62.4 (9.1) | 70 | Hypertension nurse. | no | yes | ✓ | ||||
Denver, 2003 [40] | ||||||||||||||||||||
UK 7 | RCT, 1996-1999. | 24 | Practice, 438. | Parkinson's Disease. | 9 | 1041 | nr | 57 | nr | 818 | nr | 56 | Community nurse with a course in Parkinson Disease. | no | nr | ✓ | ✓ | ✓ | ||
Jarman, 2002 [29] | ||||||||||||||||||||
UK 6 | RCT, period nr. | 4 | Health Centre Practice, 1 | Asthma | nr | 55 | Median (IQR): 35 (29-47) | 56 | 9 | 46 | Median (IQR): 37 (27-50) | 33 | Nurse with structured training in Asthma care. | no | yes | ✓ | ||||
Kernick, 2002 [27] | ||||||||||||||||||||
US 5 | RCT, 1995-1997. | 6-12, 24 | Community clinic, 4; Primary care clinic, 1. | Asthma, Diabetes Mellitus, Hypertension, or urgent visits. | 7 | 1181 | 44 | 24 | 11 | 800 | 44.9 | 22 | Community nurse practitioner. | no | nr | ✓ | ✓ | ✓ | ||
UK 5 Kernick, 2000 [28] | RCT, period nr. | 4 | Health Centre, 1 | Psoriasis and Eczema. | 1 | 55 | 47.4 (18.4) | 39 | nr | 54 | 51.7 (15.8) | 48 | Practice nurse with training in psoriasis and eczema management. | no | yes | ✓ | ||||
UK 4 | RCT, period nr | 0.5-1 | Practice, 10 | Diverse complaints. | 12 | 1465║ | range: 0 to >75 | 39 | 10 | 1465║ | range: 0->75 | 42 | Nurse practitioner with diploma on care for same day consultations for primary care. | no | nr | ✓ | ||||
Kinnersley, 2000 [26] | ||||||||||||||||||||
UK 3 | RCT, period nr. | 0.5 | Practice, 20 | Diverse complaints: e.g. minor injuries, respiratory complaints. | 20 (1 per practice) | 651 | nr | 42 | nr | 665 | nr | 43 | Nurse with course at BSc or MSc level. | no | nr | ✓ | ✓ | ✓ | ||
Venning, 2000 [17] | ||||||||||||||||||||
UK 2 | RCT, 1998-1999. | 0.5 | Practice, 5 | Acute minor illnesses. | 5 | 900 | median (IQR): 26 (9-41.8) | 40 | 19 | 915 | median (IQR): 29.1 (9.7-44.9) | 40 | Practice nurse with a course in minor illnesses and piloted before study. | no | nr | ✓ | ||||
Shum, 2000 [18] | ||||||||||||||||||||
US 4 | qRCT, 1999-2001. | 12 | Primary care veterans affair clinic, 1 | Undifferentiated conditions. | 9 | 150 | 62 | 99 | 45 | 300 | 61 | 98 | Nurse practitioner who was on staff for at least six months in primary care. | yes | yes | ✓ | ✓ | |||
Hemani, 1999 [34] | ||||||||||||||||||||
UK 1 | RCT, 1995-1996. | 12, 24, 56.4, 122.4 | Practice, 19 | Coronary Heart Disease secondary prevention. | 28 | 673 | 66.1 (8.2) | 58 | nr | 670 | 66.3 (8.2) | 58 | District and practice nurses trained in clinic protocols/GDLs for behavioural techniques change. | no | yes | ✓ | ✓ | ✓ | ✓ | |
US 3 | RCT, 1980. | 0.5 | Community clinic, 1 | Family planning, venereal diseases, acute non-traumatic minor illnesses. | 5 | 25 | nr | nr | 5 | 25 | nr | nr | Registered professional nurse with preparation and skills in physical diagnosis, psychosocial assessment, and health-illness management in primary care. | nr | yes | ✓ | ||||
Winter, 1981 [15] | ||||||||||||||||||||
US 2 | RCT, 1971. | ≥6 | HO clinic, 1; Private, 3 | Undifferentiated. | 4 | 40 | nr | nr | nr | 20 | nr | nr | Nurse clinicians with training in service delivery. | yes | nr | ✓ | ||||
Flynn, 1974 [35] | ||||||||||||||||||||
US 1 | RCT, period nr. | 12 | University Hospital clinic, 1; Nurse clinic, 1 | Hypertension, CVD, Obesity, Arthritis, Somatization. | nr | 33 | range: 16-78 | 12 | nr | 33 | range: 16-83 | 12 | Nurses who provided primary source care for at least one year before the study. | no | yes | ✓ | ✓ | ✓ | ✓ | |
Lewis, 1967 [23] | ||||||||||||||||||||