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

Publication ,  Journal Article
Shaw, RJ; McDuffie, JR; Hendrix, CC; Edie, A; Lindsey-Davis, L; Nagi, A; Kosinski, AS; Williams, JW
Published in: Ann Intern Med
July 15, 2014

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.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

July 15, 2014

Volume

161

Issue

2

Start / End Page

113 / 121

Location

United States

Related Subject Headings

  • Patient Care Team
  • Hypertension
  • Hyperlipidemias
  • Humans
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Diabetes Mellitus
  • Clinical Protocols
  • Chronic Disease
  • Cholesterol
 

Citation

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ICMJE
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Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., … Williams, J. W. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Ann Intern Med, 161(2), 113–121. https://doi.org/10.7326/M13-2567
Shaw, Ryan J., Jennifer R. McDuffie, Cristina C. Hendrix, Alison Edie, Linda Lindsey-Davis, Avishek Nagi, Andrzej S. Kosinski, and John W. Williams. “Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis.Ann Intern Med 161, no. 2 (July 15, 2014): 113–21. https://doi.org/10.7326/M13-2567.
Shaw RJ, McDuffie JR, Hendrix CC, Edie A, Lindsey-Davis L, Nagi A, et al. Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Ann Intern Med. 2014 Jul 15;161(2):113–21.
Shaw, Ryan J., et al. “Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis.Ann Intern Med, vol. 161, no. 2, July 2014, pp. 113–21. Pubmed, doi:10.7326/M13-2567.
Shaw RJ, McDuffie JR, Hendrix CC, Edie A, Lindsey-Davis L, Nagi A, Kosinski AS, Williams JW. Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Ann Intern Med. 2014 Jul 15;161(2):113–121.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

July 15, 2014

Volume

161

Issue

2

Start / End Page

113 / 121

Location

United States

Related Subject Headings

  • Patient Care Team
  • Hypertension
  • Hyperlipidemias
  • Humans
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Diabetes Mellitus
  • Clinical Protocols
  • Chronic Disease
  • Cholesterol