St Vincent's Centre for Nursing Research, Australian Catholic University, Fitzroy, Melbourne, Australia.
Int J Evid Based Healthc. 2011 Sep;9(3):199-214. doi: 10.1111/j.1744-1609.2011.00217.x.
The article summarises results of a systematic review on the effectiveness of nurse-led clinics for patients with coronary heart disease. The objective was to present the best available evidence related to effective interventions in nurse-led cardiac clinics including patient education, risk factor assessment and continuity of care.
Following the principles of the Cochrane Collaboration for systematic reviews on effectiveness, this is an update to a previously published review. Thirty databases, relevant journals and hand searching of reference lists were the basis for a comprehensive literature search for the period September 2002 to March 2008. Assessment of methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI). When possible, data was pooled in a meta-analysis.
The systematic review is based on seven randomised controlled trials. Inconsistencies of interventions executed in nurse-led clinics and various effects on the outcomes make a comparison difficult. The major nurse-led intervention applied in the clinics consisted of health education, counselling behaviour change and promotion of a healthy lifestyle. There were no harmful effects on patients with coronary heart disease identified when exposed to a nurse-led clinic. A few risk factors were significantly reduced in the short term by attending nurse-led clinics, but long-term changes were less apparent. The success of modifying behaviour such as smoking cessation and diet adherence was limited. However, nurse-led clinics may positively influence perceived quality of life and general health status.
The results indicated that care was equivalent to non-nurse-managed clinics, and there was no greater risk of poorer outcomes in the nurse-led clinics. The effectiveness of clinics might be dependent on the intensity of the nursing support. Before establishing a nurse-led clinic appropriate qualification and responsibilities, as well as the particular structure of the healthcare system and funding possibilities have to be considered. The combination of counselling and regular assessment of risk factors and health status delivered at nurse-led clinics is supported by the available research, and given that outcomes were in general equivalent between nurse-led and other clinics, further research should investigate the cost-effectiveness of the different models of care.
本文总结了一项系统评价的结果，该评价研究了护士主导的诊所对冠心病患者的有效性。目的是介绍与护士主导的心脏诊所中有效的干预措施相关的最佳现有证据，包括患者教育、风险因素评估和护理连续性。
根据 Cochrane 协作组对有效性系统评价的原则，这是对先前发表的综述的更新。我们对 2002 年 9 月至 2008 年 3 月期间的 30 个数据库、相关期刊和参考文献的手工搜索进行了全面的文献检索。使用系统评价管理工具（JBI-SUMARI）进行方法学质量评估、数据提取和综合。在可能的情况下，将数据汇总进行荟萃分析。
该系统评价基于 7 项随机对照试验。由于护士主导的诊所中执行的干预措施不一致，以及对结果的不同影响，使得比较变得困难。诊所中应用的主要护士主导干预措施包括健康教育、行为改变咨询和促进健康的生活方式。在接受护士主导的诊所治疗时，没有发现冠心病患者有任何不良影响。短期内在护士主导的诊所接受治疗可以显著降低一些风险因素，但长期变化不太明显。改变行为（如戒烟和饮食依从性）的效果有限。然而，护士主导的诊所可能会对感知的生活质量和总体健康状况产生积极影响。
结果表明，护理与非护士管理的诊所相当，并且在护士主导的诊所中没有更高的不良结局风险。诊所的有效性可能取决于护理支持的强度。在建立护士主导的诊所之前，必须考虑适当的资格和责任，以及特定的医疗保健系统结构和资金可能性。现有的研究支持在护士主导的诊所中提供咨询以及定期评估风险因素和健康状况的组合，鉴于结果在护士主导的诊所和其他诊所之间总体上是等效的，进一步的研究应该调查不同护理模式的成本效益。
