Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis.

Published

Journal Article (Review)

BACKGROUND: Changes in federal health policy are providing more access to medical care for persons with chronic disease. 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. PURPOSE: To determine whether nurse-managed protocols are effective for outpatient management of adults with diabetes, hypertension, and hyperlipidemia. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and CINAHL from January 1980 through January 2014. STUDY SELECTION: Two reviewers used eligibility criteria to assess all titles, abstracts, and full texts and resolved disagreements by discussion or by consulting a third reviewer. DATA EXTRACTION: One reviewer did data abstractions and quality assessments, which were confirmed by a second reviewer. DATA SYNTHESIS: From 2954 studies, 18 were included. All studies used a registered nurse or equivalent who titrated medications by following a protocol. In a meta-analysis, hemoglobin A1c level decreased by 0.4% (95% CI, 0.1% to 0.7%) (n = 8); systolic and diastolic blood pressure decreased by 3.68 mm Hg (CI, 1.05 to 6.31 mm Hg) and 1.56 mm Hg (CI, 0.36 to 2.76 mm Hg), respectively (n = 12); total cholesterol level decreased by 0.24 mmol/L (9.37 mg/dL) (CI, 0.54-mmol/L decrease to 0.05-mmol/L increase [20.77-mg/dL decrease to 2.02-mg/dL increase]) (n = 9); and low-density-lipoprotein cholesterol level decreased by 0.31 mmol/L (12.07 mg/dL) (CI, 0.73-mmol/L decrease to 0.11-mmol/L increase [28.27-mg/dL decrease to 4.13-mg/dL increase]) (n = 6). LIMITATION: Studies had limited descriptions of the interventions and protocols used. CONCLUSION: 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. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

Full Text

Duke Authors

Cited Authors

  • Shaw, RJ; McDuffie, JR; Hendrix, CC; Edie, A; Lindsey-Davis, L; Nagi, A; Kosinski, AS; Williams, JW

Published Date

  • July 2014

Published In

Volume / Issue

  • 161 / 2

Start / End Page

  • 113 - 121

PubMed ID

  • 25023250

Pubmed Central ID

  • 25023250

Electronic International Standard Serial Number (EISSN)

  • 1539-3704

International Standard Serial Number (ISSN)

  • 0003-4819

Digital Object Identifier (DOI)

  • 10.7326/m13-2567

Language

  • eng