Table 4 Literature Review Table – System Outcomes

Bellary et al., 2008 [52]

UK

Economic analysis of net intervention cost (staff salaries, travel and subsistence, equipment, payment to practices, and prescribing) over 2 years

The economic analysis shows that financial investment needed over 2 years did not produce significant enough health-related gain in quality of life to make the nurse-led intervention clearly cost-effective.

Iles et al., 2014 [60]

Australia

Total MBS item charges over a 1-year study period

There was an estimated $129 (Australian dollars) mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life, and geographic location of practice) associated with PN-led care. Based on cost calculations of salaries and expenditures at the time of the study, it was concluded that Medicare reimbursements provide sufficient funding for general practices to employ PNs within limits of workloads

Karnon et al., 2013 [61]

Australia

Cost-effectiveness analysis specifically related to primary care, pharmaceutical, and hospital costs

High-level model patients incurred greater primary care and pharmaceutical-related costs, though hospital costs were greater in the low-level model patients. Incrementally, the high-level model gets one additional obese patient to lose weight at an additional cost of $6741, and reduces mean BMI by an additional one point at an additional cost of $563 (upper 95% CI: $1547).

Low et al., 2005 [63]

UK

Cost of each intervention strategy per positive chlamydia index case in 2003 sterling prices

The costs of the two strategies were similar in both study arms: £32.55 (95% CI: 31.20 to 33.91) for the PN-led strategy and £32.62 (95% CI: 31.49 to 33.73) for the specialist referral strategy.

Gallagher et al., 1998 [57]

UK

Changes to number of GP and nurse consultations over three-month study period

Doctor workload fell by 54%, from 1522 to 664 consultations, compared with the previous three months. The number of other appointments provided by the nurses fell by 21%, from 1793 to 1415 appointments. Telephone triage of patients who were contacting the clinic for a same-day appointment reduced doctor workload.

Iles et al., 2014 [60]

Australia

Frequency of patient visits to GP and PN

The frequency of GP and PN visits varied markedly according to chronic disease. Cardiovascular disease patients in the PN-led care group made more PN visits than the GP-led care group (4.97 v. 3.23; p = 0.013), diabetes patients in the PN-led care group had more PN visits than the GP-led care group (13.29 v. 1.63; p < 0.001) and hypertension patients in the PN-led care group had marginally more PN visits than the GP-led care group (4.80 v. 3.12; p = 0.013). The notion that PN-led model of care would free up GP workload was not supported.

Aubert et al., 1998 [50]

USA

Episodes of severe hypoglycemia; emergency room and hospital admissions

There were no statistically significant differences between nurse case management groups and usual care for adverse events.

Harris et al., 2015 [58]

UK

Falls, fractures, sprains, injuries, or any deterioration of health problems already present at 3 and 12 months

There were no between-group differences in number of adverse events at 3 or 12 months.

Harris et al., 2017 [59]

UK

Falls, injuries, fractures, cardiovascular events, deaths at 3 and 12 months

Total adverse events did not differ between groups at 3 or 12 months, however, cardiovascular events over 12 months were lower in the intervention groups than in controls (p = 0.04).

Cherkin et al., 1996 [53]

USA

Number of back pain-related visits made by patients to family physicians or other providers between the 3, 7, and 52 week evaluations, as well as number of hospitalizations

The proportion of subjects making at least one visit for low back pain and the mean number of visits were similar for all groups at each follow-up interval; the interventions had no impact on health care use.

Gallagher et al., 1998 [57]

UK

Repeat consultations to a general practice for the same acute care related problem

Repeat consultations were significantly higher after one week for nurse consultations than doctor consultations (52% v. 37%; 95% CI: 2 to 28%; p = 0.02).