Effectiveness of community-based health services by nurse practitioners: protocol for a systematic review and meta-analysis

Abstract

IntroductionTo realise universal health coverage in an ageing society, adequate provision of appropriately trained human resources is essential. The nurse practitioner (NP) is an autonomous and independent, advanced practice nurse capable of providing treatment and care that can be substituted for some aspects of a medical doctor's (MD's) role, especially in a community setting. Previous systematic reviews found higher levels of patient satisfaction with services provided by NPs than those provided by MDs. As non-communicable diseases become a major health burden requiring long-term healthcare in community settings, this systematic review aims to assess the equivalence of NP services to standard care provided by MDs, and to determine whether their practice is an effective alternative to that of MDs in community settings.Methods and analysisRelevant randomised controlled trials (RCTs) and cluster RCTs will be searched in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and the British Nursing Index. We will assess patient and health system utilisation outcomes of interventions comparing treatment and care provided by NPs in community settings with that provided by MDs. Two authors will independently screen studies for inclusion, consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool, and quality of evidence using the GRADE approach. Meta-analysis of included studies will be conducted using fixed-effect or random-effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95% CI for dichotomous outcomes and standardised mean differences with 95% CI for continuous outcomes.Ethics and disseminationThis systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Trial registration numberPROSPEROCRD42014009627.

Outcomes of Patient Education in Nurse-led Clinics: A Systematic Review

“…The non-evaluated outcomes in the reviewed investigations include caregiver role endurance, caregiver stressors, caregiver emotional health, family coping, parenting performance, community disaster readiness, and community health screening effectiveness. However, nowadays, family and society play a crucial role in home-care due to the population aging and the spread of lifestyle-related chronic diseases 44,45 so that the contemporary society requires human resources for health 46 and medical and nursing services to provide home-care services. 47,48 Thus, it requires further study to best understand what it is the nurse may be teaching in these domains.…”

Exploration of advanced practice nurses' competencies necessary for achievement of universal health coverage in Jordan

“…Globally, there is more recognition and interest about the positive impact that APNs may bring to patients' outcomes. Kanda et al 15 emphasized the significant role of APNs in autonomously providing primary health care. In their meta‐analysis review of 11 trials and 23 descriptive studies 15 .…”

“…Kanda et al 15 emphasized the significant role of APNs in autonomously providing primary health care. In their meta‐analysis review of 11 trials and 23 descriptive studies 15 . Horrocks, Anderson, and Salisbury 18 found a higher level of satisfaction among patients who received care from NPs compare with those who received care from physicians.…”

“…Giving the global shortage of the health workforce, most countries are looking for strategies to improve their health care systems. One solution as indicated by Kanda et al 15 is to utilize advanced practice nurses (APNs) to provide primary health care autonomously and independently. APN/Nurse Practitioner (NP) is defined according to International Nursing Council (ICN) as “a registered nurse who has acquired the expert knowledge base, complex decision‐making skills, and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice.…”

Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

“…One solution is to utilize APNs to provide PHC autonomously and independently, through the performance of assessments and diagnoses, ordering diagnostic and laboratory tests, as well as prescribing medications and offering treatments. In addition, APNs could monitor patients’ adherence to medical plans, and offer both counseling and education for non-communicable disease prevention 15 .…”