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Study: Nurse-led interventions can help patients with chronic diseases

Friday July 18, 2014
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Nurse-led interventions are associated with improved biomarkers in patients with common chronic diseases, according to a meta-analysis in the Annals of Internal Medicine.

In a review published online July 15, RN researchers and their colleagues examined the results of 18 studies (more than 23,000 patients) and concluded a team approach that uses nurse-managed protocols may have positive effects on the outpatient management of adults with chronic conditions, such as diabetes, hypertension and hyperlipidemia.

According to the background information in the meta-analysis, “Providing quality care may require a team approach, which the American College of Physicians calls the ‘medical home.’ One new model may involve nurse-managed protocols.”

Outcomes in the meta-analysis that favored nurse-led care, included:

• Hemoglobin A1C levels decreased by roughly 0.4% with nurse-led versus usual care.

• Systolic and diastolic blood pressure was reduced by 3.68 mm Hg and 1.56 mm Hg, respectively.

• Total cholesterol was reduced by 0.24 mmol/L and LDL cholesterol by 0.31 mmol/L, although these reductions were not statistically significant, according to a news release.

Medical management of chronic illness consumes 75% of every healthcare dollar spent in the U.S., and diabetes mellitus, hypertension and hyperlipidemia are prime examples of chronic diseases that cause substantial morbidity and mortality and require long-term medical management, according to the review. “Robust evidence supports the effectiveness of nurses in providing patient education about chronic disease and secondary prevention strategies,” the authors wrote. “With clearly defined protocols and training, nurses may also be able to order relevant diagnostic tests, adjust routine medications and appropriately refer patients.”

Because 11 of the 18 studies were done in Western Europe, the authors gathered information on education and scope of practice of the nurse interventionists outside of the U.S.

The authors said the study’s strengths included a protocol-driven review, a comprehensive search, careful quality assessment and rigorous quantitative synthesis methods, according to the article. “However, our report and the literature also have limitations,” the authors wrote, including not reviewing studies of inpatient settings in which nurses might often use protocols and a lack of detailed descriptions of the interventions and protocols used in the studies’ literature and nurses’ education levels, training or supervision.

“The implementation of a patient-centered medical home model will play a critical role in reconfiguring team-based care and will expand the responsibilities of team members,” the authors said. “Our review shows that team approaches using nurse-managed protocols help improve health outcomes among patients with moderately severe diabetes, hypertension, and hyperlipidemia. ... As the largest healthcare workforce group, nurses are in an ideal position to collaborate with other team members in the delivery of more accessible and effective chronic disease care. Thus, healthcare systems will need to balance the benefits and costs associated with each team member and determine who is best suited to take on these expanded roles.”

The authors said that further research is needed to understand the effects of nurse-managed protocols in caring for complex or unstable patients.

Primary funding for the study came from the U.S. Department of Veterans Affairs.

Read the study: http://annals.org/article.aspx?articleid=1887028


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