Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians

Abstract

BackgroundPrimary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primary care setting.MethodsA search of Medline, Embase, PsycInfo, and CINAHL databases was undertaken to locate controlled intervention trials published between 1992 and May 2014 that provided practice change interventions to primary care nurses and/or allied health professionals to increase preventive care. The effect of interventions aimed at increasing the provision of any of the five care elements for any of the four behavioural risks was examined. A narrative synthesis was utilised.ResultsFrom 8109 articles, seven trials met the inclusion criteria. All trials bar one, assessed multi-strategic practice change interventions (three to five strategies) focused on care by nurses (six trials) or mixed nursing/allied health clinicians. One trial examined care provision for all four risks, five trials examined care for smoking only, and one trial examined care for alcohol consumption only. For the six trials reporting significance testing (excludes one smoking care trial), significant effects favouring the intervention group were reported in at least one trial for smoking risk assessment (2/4 trials reported an effect for at least one analysis of an assessment outcome), brief advice (2/3), assistance (2/2), and arranging referral (2/3); alcohol risk assessment (1/2) and brief advice (1/2); inadequate nutrition risk assessment (1/1); and physical inactivity risk assessment and brief advice (1/1). When the number of analyses undertaken within trials focusing on smoking care was considered, the results were less promising (e.g. of the 15 analyses conducted on brief advice variables across three trials, four showed a positive effect).ConclusionsEvidence for the effect of practice change interventions on preventive care by primary care nurses or allied health providers is inconclusive given the small number of trials and inconsistency of results between and within trials.Systematic review registration numberNoneElectronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0409-3) contains supplementary material, which is available to authorized users.

Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial

“…Due to the short intervention time, we defined it as a brief intervention compared with the standard protocol for telephone smoking cessation counseling of 35 to 45 min per session42. Studies have shown that a brief intervention such as oral advice or brief counseling would be cost-effective and easy to implement for physicians or nurses in clinic or hospital settings to promote the rate of quitting in patients4344. Another intervention study was a subject-centered motivational intervention that focused on promoting the reasons to quit, on emphasizing this choice, on achieving goal and on the subject’s resistance to quitting45.…”

Interventions for Increasing the Quality of Preventive Care at a Free Clinic

“…Even with the HTN control performance not being statistically significantly different compared with the Healthy People 2020 goals, we still consider this particular intervention as in need of another cycle of improvement interventions. Future interventions for improvement of diabetes and HTN control should include other interventions previously shown to be effective [13][14][15], including educational conferences and courses for providers with updates in the management of diabetes and HTN and offering rewards for performance at goal.…”

Systematic review of interventions to increase the provision of care for chronic disease risk behaviours in mental health settings: review protocol

“…Studies will be included if they quantitatively assess the provision or receipt of at least one care element (ask, assess, advice, assist and arrange) for at least one chronic disease risk behaviour (tobacco smoking, poor nutrition, harmful alcohol consumption or physical inactivity) in the context of mental health service delivery. Use of the 5As terminology for the elements of care will not be required and will be inferred by the extractor based on definitions [ 20 , 51 ] of the 5As [ 52 ]. Broadly, ask will be asking clients about their current behaviour levels for at least one of the risk behaviours.…”

“…mental health service, psychosocial support service, community mental health), (b) the four risk behaviours (tobacco smoking, poor nutrition, physical inactivity and harmful alcohol consumption), and (c) the study type (intervention or implementation studies). Search filters will be included for mental health service types and risk behaviours that were used in other, similar systematic reviews [ 52 , 53 ]. Search terms for study type (interventions and implementation studies) will be adapted from a glossary for dissemination and implementation research [ 54 ] and similar systematic reviews [ 55 ].…”