Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Int J Nurs Stud. 2018 Feb;78:37-43. doi: 10.1016/j.ijnurstu.2017.08.018. Epub 2017 Aug 31.
The creation of advanced nursing roles in diabetes management, with specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors.
We aimed to examine the effectiveness of nurse-led clinics, in which nurses were involved in prescribing, on haemoglobin A1c (HbA1c) among people with type 2 diabetes.
We systematically searched the literature, Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Allied Health Literature database guide (CINAHL) databases, to identify randomised controlled trials (RCTs) assessing the effect of nurse prescribers on HbA1c. We focused on randomised controlled trials which compared nurse prescriber interventions with usual care in adults aged 18 years or over with a diagnosis of type 2 diabetes. The main outcome measure was change in HbA1c levels. We performed a random effects model meta-analysis to assess the pooled effect size of the intervention. Studies were divided into two groups according to the role of nurses in the intervention. In one group, the nurses supplemented a team, as an add-on to usual care; in the other group, they worked independently, and were compared directly to a doctor.
Nine RCTs were identified and included in this study. All studies were from developed countries, with a medium risk of bias and a moderate heterogeneity between studies. In the five RCTs in which nurse prescribers supplemented a team, there was no significant difference in change of HbA1c compared to usual care (-0.34 percentage points; 95% CI: -0.71, 0.02). In the four RCTs in which nurses replaced doctors, the outcomes of nurse prescribers were comparable to those of doctors. No data on adverse events were available.
There was no clear evidence of benefit on glycaemic control, when nurses who undertake prescribing work alongside a doctor and other practitioners. However, in those studies in which nurses replaced physicians, the glycaemic control was comparable between nurses and doctors. Therefore, there may be value in providing nurse-led prescribing services where there is limited access to doctor-led services.
在糖尿病管理中创建高级护理角色，具有护士处方等特定技能，导致护士承担传统上与医生相关的角色。
我们旨在研究护士主导的诊所对 2 型糖尿病患者的血红蛋白 A1c（HbA1c）的有效性，其中护士参与处方。
我们系统地搜索了文献，包括 Medline、Cochrane 对照试验中心注册库（CENTRAL）、EMBASE 和联合健康文献数据库指南（CINAHL）数据库，以确定评估护士处方者对 HbA1c 影响的随机对照试验（RCT）。我们专注于将护士处方干预与年龄在 18 岁或以上且诊断为 2 型糖尿病的成人的常规护理进行比较的 RCT。主要观察指标是 HbA1c 水平的变化。我们进行了随机效应模型荟萃分析，以评估干预的合并效应大小。根据护士在干预中的角色，将研究分为两组。在一组中，护士作为常规护理的补充，加入团队；在另一组中，他们独立工作，并与医生直接比较。
确定了 9 项 RCT 并纳入本研究。所有研究均来自发达国家，存在中度偏倚风险和研究之间存在中度异质性。在五项护士处方者补充团队的 RCT 中，与常规护理相比，HbA1c 的变化无显著差异（-0.34 个百分点；95%CI：-0.71，0.02）。在四项护士替代医生的 RCT 中，护士处方者的结果与医生相当。没有关于不良事件的数据。
当护士与医生和其他从业者一起从事处方工作时，在血糖控制方面没有明显的获益证据。然而，在那些护士替代医生的研究中，护士和医生的血糖控制相当。因此，在医生主导的服务有限的情况下，提供护士主导的处方服务可能具有价值。
