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护士主导的诊所对患有慢性耳鼻喉疾病的成年人服务提供和临床结局的有效性:一项系统评价。

Effectiveness of nurse-led clinics on service delivery and clinical outcomes in adults with chronic ear, nose and throat complaints: a systematic review.

作者信息

Whiteford Caroline, White Sarahlouise, Stephenson Matthew

机构信息

1Surgical Specialties Outpatients, Royal Adelaide Hospital Australia 2Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia.

出版信息

JBI Database System Rev Implement Rep. 2016 Apr;14(4):229-56. doi: 10.11124/JBISRIR-2016-2237.


DOI:10.11124/JBISRIR-2016-2237
PMID:27532317
Abstract

BACKGROUND: Ear, nose and throat complaints are very common and can cause significant disruption to patients' lives. Many conditions are of a chronic nature and are not currently managed in a timely manner by general practitioners in the community. This may be due to a lack of specialized knowledge, necessary diagnostic equipment or time for lengthy patient education on management of their condition. A nurse-led model of care may be an effective alternative. OBJECTIVE: To examine the effectiveness of nurse-led clinics on adults with chronic ear, nose and throat complaints. INCLUSION CRITERIA PARTICIPANTS: Adult patients, aged 18 years and older, attending ear, nose and throat clinics, regardless of the complaint. INTERVENTIONS: Nurse-led care in general practice and acute care in which the nurse was identified as taking a lead role in the care of the patients with chronic ear, nose and throat complaints. COMPARATOR: General practitioner-led care, or ear, nose and throat consultant-led care, sometimes described as "standard care". OUTCOMES: Service delivery outcomes, clinical and health outcomes and financial outcomes. STUDIES: Any relevant quantitative studies published in English between 1980 and 2013 were considered. SEARCH STRATEGY: A standardized three-step search strategy aimed to find both published and unpublished studies. Databases searched include PubMed, CINAHL, Cochrane Library (CENTRAL), Scopus, Embase, MedNar and ProQuest Theses and Dissertations. METHODOLOGICAL QUALITY: Methodological validity was assessed independently by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA SYNTHESIS: Due to methodological heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. RESULTS: The search identified 13,536 titles, of which 20 potentially relevant articles were retrieved. Of these 20, 17 were excluded following full-text review leaving three studies that were assessed for methodological quality and included in the review. Service delivery outcome findings were that patient satisfaction was equal or higher and waiting times were shorter in nurse led clinics. The other service delivery outcomes were not addressed. Clinical and health outcomes findings were that lower pain/discomfort levels were demonstrated in nurse led clinics but other clinical/health outcomes were not addressed. Financial outcomes findings were that nurse-led clinics were cost effective when compared with medical-led clinics. CONCLUSIONS: While all studies reported evidence of the effectiveness of nurse-led clinics in service delivery and clinical outcomes in adults with chronic ear, nose and throat complaints, most of the data was self-reported and many of the outcomes of interest were not considered. The lack of experimental trials means that the level of evidence is low and further research is needed. There was also not enough detail in the financial outcomes from which clear conclusions of the cost benefit of nurse-led clinics could be drawn. IMPLICATIONS FOR PRACTICE: Evidence from included studies indicated higher levels of patient satisfaction, cost benefits and lower levels of pain/discomfort in nurse-led clinics, which suggests that nurse-led ear, nose and throat clinics may be considered in the management of adult patients with ear, nose and throat complaints. IMPLICATIONS FOR RESEARCH: Currently there is little evidence examining the effectiveness of nurse-led ear, nose and throat clinics. Areas to be addressed by future research should include: levels of patient education, booking queues, levels of self-treatment change in presentation to clinic episodes, reinfection rates, prevention and cure and representation of patients at clinics for same complaint.

摘要

背景:耳鼻喉科疾病非常常见,会严重影响患者的生活。许多病症具有慢性特征,目前社区全科医生无法及时进行有效管理。这可能是由于缺乏专业知识、必要的诊断设备,或者没有时间对患者进行关于病情管理的长时间健康教育。由护士主导的护理模式可能是一种有效的替代方案。 目的:探讨由护士主导的诊所对患有慢性耳鼻喉科疾病的成年人的有效性。 纳入标准参与者:18岁及以上的成年患者,前往耳鼻喉科诊所就诊,不限病症。 干预措施:全科医疗中由护士主导的护理以及急症护理,其中护士在患有慢性耳鼻喉科疾病患者的护理中发挥主导作用。 对照:由全科医生主导的护理,或由耳鼻喉科顾问主导的护理,有时被称为“标准护理”。 结果:服务提供结果、临床和健康结果以及财务结果。 研究:考虑1980年至2013年间以英文发表的任何相关定量研究。 检索策略:采用标准化的三步检索策略,旨在查找已发表和未发表的研究。检索的数据库包括PubMed、CINAHL、Cochrane图书馆(CENTRAL)、Scopus、Embase、MedNar和ProQuest论文与学位论文数据库。 方法学质量:由两名评审员使用乔安娜·布里格斯研究所的标准化批判性评价工具独立评估方法学有效性。 数据综合:由于纳入研究的方法学异质性,无法进行统计合并,所有结果均以叙述形式呈现。 结果:检索到13536个标题,其中检索到20篇可能相关的文章。在这20篇文章中,经过全文审查后排除了17篇,剩下3项研究进行了方法学质量评估并纳入综述。服务提供结果发现,在由护士主导的诊所中,患者满意度相同或更高,等待时间更短。其他服务提供结果未涉及。临床和健康结果发现,在由护士主导的诊所中疼痛/不适水平较低,但其他临床/健康结果未涉及。财务结果发现,与由医生主导的诊所相比,由护士主导的诊所具有成本效益。 结论:虽然所有研究都报告了由护士主导的诊所在为患有慢性耳鼻喉科疾病的成年人提供服务和临床结果方面有效性的证据,但大多数数据是自我报告的,许多感兴趣的结果未被考虑。缺乏实验性试验意味着证据水平较低,需要进一步研究。财务结果中也没有足够的细节,无法得出关于由护士主导的诊所成本效益的明确结论。 对实践的启示:纳入研究的证据表明,在由护士主导的诊所中患者满意度更高、具有成本效益且疼痛/不适水平更低,这表明在管理患有耳鼻喉科疾病的成年患者时可考虑由护士主导的耳鼻喉科诊所。 对研究的启示:目前几乎没有证据检验由护士主导的耳鼻喉科诊所的有效性。未来研究应解决的领域包括:患者教育水平、预约排队、自我治疗水平在就诊期间的变化、再感染率、预防和治愈以及同一病症患者在诊所的就诊情况。

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