From: Effectiveness of registered nurses on system outcomes in primary care: a systematic review
Author, Year, Country | Description of Outcome | Results |
---|---|---|
Quality of Assessment and Screening | ||
Azariah et al., 2013 [51] New Zealand | Number of chlamydia tests completed | There was a large increase in chlamydia testing, with a high prevalence found in the population tested. During the pilot, there was a 300% increase in the number of chlamydia tests in the target age group from 812 to 2410 and the number of male tests increased by nearly 500%. Nurse-led opportunistic testing for chlamydia in primary care is successful at increasing testing in both males and females. |
Daly et al., 2000 [54] New Zealand | Rate of foot examinations and foot care education activities performed by PNs in 2006–2008 and in 2016 | Significantly more nurses in 2016 than in 2006–2008 self-reported routinely examining patients’ feet (45% versus 31%) and giving foot-care education (28% versus 13%). District nurses were more likely to conduct foot examinations in 2016; however, PNs were significantly more likely than district nurses and specialist nurses to test sensation (p = 0.0005). PNs receiving diabetes education (> 5 h) within the last five years was positively associated with conducting foot examinations and providing recommended foot care education. PNs have significantly expanded their role in managing people with diabetes over the last decade by increasing the number of foot examinations and providing recommended foot-care education. |
Farford et al., 2021 [55] USA | Number of preventative services utilized by patients (mammography, colon cancer screening, bone mineral analysis, pneumococcal vaccination, influenza vaccination, screening for hepatitis C, and screening for depression) | Each preventive service was utilized more often by patients in the annual wellness visit group than the standard assessment group (all ORs ≥1.64; all p-values ≤0.004). The preventive services with the greatest improvement in the annual wellness visit group compared to standard assessment were depression screening (OR = 4.15; 95% CI: 2.57 to 6.70; p < 0.001) and mammogram (OR = 3.87; 95% CI: 2.00 to 7.50; p < 0.001). A RN-led Medicare annual wellness visit is an effective way of assisting Medicare beneficiaries in meeting their preventative care needs. |
Low et al., 2005 [63] UK | Proportion of index cases with at least one treated sexual partner | Overall, 45% (92/206) of contacts of 140 index cases were considered treated: 65.3% (47/72) of cases seen by a PN and 52.9% (39/68) in the control group had at least one sexual partner treated ((OR = 12.4; 95% CI: 1.8 to 26.5; p = 0.087). There was no significant difference between the two treatment arms (risk difference 7.9%; CI: -8.4 to 24.0%). PNs with appropriate training and support from health advisors to carry out telephone follow-up can provide immediate partner notification for community diagnosed chlamydia that is at least as effective as referral to a specialist health advisor at a genitourinary medicine clinic. |
Moher et al., 2001 [64] UK | Assessment of heart disease at 18 months based on 3 risk factors: blood pressure, cholesterol and smoking status | The groups differed substantially in the proportions of patients being adequately assessed; the absolute increase in the proportion of patients who received adequate assessment compared with the audit group was 33% (95% CI: 19 to 46%) in the nurse group and 23% (95% CI: 10 to 36%) in the GP recall group. Adequate assessment was higher in the nurse group than the GP recall group (85% v. 76%), but the difference was not significant. The other components of adequate assessment all followed a similar pattern. |
Plummer et al., 2000 [66] UK | Level of agreement between PN assessment and General Health Questionnaire classification of psychiatric morbidity | The mean detection rate by PNs when identifying significant distress was 16% (between nurse variation, 0 to 61%). A second analysis, changing the nurse criterion to recognition of distress, increased the mean sensitivity rate to 58% (variation 31 to 84%). There was, however, a statistically significant increase in the OR for nurse identification using either criterion, as the General Health Questionnaire score increases (i.e., a higher proportion of more severe cases were detected). Overall, agreement with the General Health Questionnaire classification was modest, however, as patients’ symptoms become more severe, a higher proportion of cases were identified. |
Quality of Smoking Cessation Support | ||
Faulkner et al., 2016 [56] UK | Provision and quality of smoking cessation support as defined by time taken for consultation, pharmacotherapies prescribed, advise delivered, and number and type of interim contacts | There was no statistically significant difference in advice delivered, or types of pharmacotherapies prescribed. Compared with nurses, HCA consultations were longer on average (p = 0.002) and made more interim contacts (p < 0.001). Nurses and HCAs appear to be equally effective at supporting smoking cessation, however, nurses appear to be able to provide equivalent care with less patient contact. |
Katz et al., 2004 [62] USA | Performance of guideline-recommended smoking cessation counseling activities (after adjustment for patient-level covariates, intake clinicians’ characteristics, and study site) | Performance of all guideline-recommended counseling activities were significantly greater for all types of nursing personnel at test v. control sites. Adjusting for patient- and visit-related covariates demonstrated that medical assistants were significantly less likely to assess willingness to quit (OR = 0.4, 95% CI = 0.2 to 0.8; p = 0.005) and tended to offer advice and assistance in quitting less often than RNs. Similar findings were observed for LPNs when compared with RNs (OR = 0.5; 95% CI: 0.3 to 1.0; p = 0.03). Although both medical assistants and LPNs showed marked improvements in performance in response to the guideline intervention, patients seen by these intake clinicians were less likely to receive guideline-recommended counseling, compared to those patients seen by RNs. |
Chlamydia Case Management | ||
Azariah et al., 2013 [51] New Zealand | Level of documentation of partner notification in diagnosed cases of chlamydia | The pilot resulted in the recording of more information regarding follow-up and outcomes of partner notification in the Patient Management System. |
Number of chlamydia tests completed | There was a large increase in chlamydia testing, with a high prevalence found in the population tested. During the pilot, there was a 300% increase in the number of chlamydia tests in the target age group (812 to 2410) and the number of male tests increased by nearly 500%. Nurse-led opportunistic testing for chlamydia in primary care is successful at increasing testing in both males and females. | |
Low et al., 2005 [63] UK | Proportion of index cases with at least one treated sexual partner | Overall, 45% (92/206) of contacts of 140 index cases were considered treated: 65.3% (47/72) of cases seen by a PN and 52.9% (39/68) cases in the control group had at least one sexual partner treated (OR = 12.4; 95% CI: 1.8 to 26.5; p = 0.087). There was no significant difference between the two treatment arms (risk difference 7.9%; CI: -8.4 to 24.0%). PNs with appropriate training and support from health advisors to carry out telephone follow-up can provide immediate partner notification for community diagnosed chlamydia that is at least as effective as referral to a specialist health advisor at a genitourinary medicine clinic. |
Access to Appropriate Medications (Illness Management) | ||
Gallagher et al., 1998 [57] UK | Number of consultations that resulted in the issuing of a prescription | A total of 51% consultations resulted in a prescription (21% telephone consultations, 51% nurse consultations, 66% doctor consultations, and 65% consultations with both nurse and doctor). |
Moher et al., 2001 [64] UK | Amount of hypotensive agents, lipid lowering drugs, and antiplatelet drugs prescribed | Prescribing of hypotensive and lipid lowering agents varied little between the nurse recall, GP recall and audit groups. Prescribing of antiplatelet drugs increased in all groups, but at follow-up the nurse recall group had achieved higher levels of prescribing than the audit group (10% more) and the GP recall group (8% more). |
O’Neill et al., 2004 [65] USA | Intensification of patient medication levels for hypertension | All patients (n = 126) in the study received medication intensification at the index visit, regardless of intervention type. |
Laboratory Monitoring | ||
O’Neill et al., 2004 [65] USA | Relevant laboratory monitoring of patients, defined as an issuing of a basic metabolic panel within 4 weeks of initiation or intensification of a diuretic, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or aldosterone antagonist | Laboratory monitoring within 4 weeks of initiation or intensification of a diuretic, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or aldosterone antagonist was completed in 7 out of 37 possible cases in the CPS group (19%) and 14 out of 39 possible cases in the physician group (36%; p = 0.13). |