Martínez-González Nahara Anani, Rosemann Thomas, Tandjung Ryan, Djalali Sima
Institute of Primary Care, University Hospital Zurich, University of Zurich, Switzerland.
Swiss Med Wkly. 2015 Feb 4;145:w14031. doi: 10.4414/smw.2015.14031. eCollection 2015.
Chronically ill and ageing populations demand increasing human resources who can provide on-going and frequent follow-up care. We performed a systematic review to assess the effect of physician-nurse substitution on process care outcomes.
We searched OVID Medline, Embase, CINAHL and The Cochrane Library for all available dates up to August 2012 and updated in February 2014. We selected and critically appraised published randomised controlled trials (RCT) and followed the PRISMA guidelines for the reporting of systematic reviews.
A total of 14 RCTs comprising 10,743 participants met the inclusion criteria. Studies were generally small and suffered from attrition of ≥20% and selection biases. There were 53 process measurements investigated in the 14 RCTs, many of which were unique to specific conditions. Accounts of nurses' roles, responsibilities, tasks, qualifications and training content/components were not described in sufficient detail. Most study estimates showed no significant differences between nurse-led care and physician-led care while less than a half (~40%) favoured nurse-led care.
Despite the methodological limitations and the varying nurses' roles and competencies across studies, specially trained nurses can provide care that is at least as equivalent to care provided by physicians for the management of chronic diseases, in terms of process of care. Future, larger studies with better quality methods are needed and should report and assess whether the differences in effects vary due to diversity in roles, qualifications, training competencies and characteristics of clinicians delivering substitution of care.
慢性病患者群体及老年人口对能够提供持续且频繁随访护理的人力资源需求日益增加。我们进行了一项系统评价，以评估医生 - 护士替代对护理过程结果的影响。
我们检索了截至2012年8月所有可用日期的OVID Medline、Embase、CINAHL和Cochrane图书馆，并于2014年2月进行了更新。我们选择并严格评估已发表的随机对照试验（RCT），并遵循PRISMA指南报告系统评价。
共有14项RCT（涉及10,743名参与者）符合纳入标准。研究规模普遍较小，存在≥20%的损耗和选择偏倚。14项RCT中调查了53项护理过程指标，其中许多指标特定于某些情况。护士的角色、职责、任务、资质和培训内容/组成部分的描述不够详细。大多数研究估计显示，护士主导的护理与医生主导的护理之间无显著差异，只有不到一半（约40%）的研究支持护士主导的护理。
尽管存在方法学局限性以及各研究中护士角色和能力的差异，但就护理过程而言，经过专门培训的护士能够提供至少与医生提供的护理相当的慢性病管理护理。未来需要开展更大规模、方法质量更高的研究，并且应报告和评估由于提供替代护理的临床医生在角色、资质、培训能力和特征方面的差异，影响是否有所不同。
