Wang Qun, Shen Yan, Chen Yongmin, Li Xiaohua
Department of Nursing, Huzhou Wuxing Hospital of Integrated Traditional Chinese and Western Medicine.
Department of Internal Medicine, The First Affiliated Hospital of Huzhou University.
Medicine (Baltimore). 2019 Jun;98(23):e15971. doi: 10.1097/MD.0000000000015971.
To evaluate the impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c (HbA1c) control in type 2 diabetes.
We searched relevant publications in English and Chinese database and conducted meta-analysis by Stata 12.0. We divided the case groups of included studies into 2 categories according to the role of nurse: nurse-led clinic and nurse-led prescription. Nurse-led clinic was implemented on the basis of standard diabetes care provided by doctor, and control group also receive the standard diabetes care but without nurse-led clinic. The doctor mentioned above might work alone or in a health care team. Nurse-led prescription was prescribed by nurse independently and compared with that of doctor.
The meta-analysis shown that, compared with the standard diabetes care, nurse-led clinic significantly decreases HbA1c level (standard mean difference [SMD] = -0.767; 95% confidence interval [CI]: -1.062, -0.471; P < .001). In subgroup analysis, nurse-led clinic also had positive impacts on controlling HbA1c level, no matter in developed countries (SMD = -0.353; 95% CI: -0.6, -0.106; P = .005) or developing countries (SMD = -1.114; 95% CI: -1.498, -0.73; P < .001). Additionally, there was no significant difference between nurse-led prescription and doctor prescription in controlling HbA1c levels (SMD = -0.203; 95% CI: -0.434, 0.029; P = .086).
The nurse-led clinic had positive significance for HbA1c control. Meanwhile, the impact of nurse-led prescription on controlling HbA1c is comparable to that of doctor. It is valuable to provide nurse-led clinic on the basis of standard diabetes care provided by doctor to better control HbA1c, and nurse-led prescription should be provided when doctor-led service is limited.
评估护士主导的诊所及护士主导的处方对2型糖尿病患者糖化血红蛋白（HbA1c）控制的影响。
检索英文和中文数据库中的相关出版物，并使用Stata 12.0进行荟萃分析。根据护士的角色，将纳入研究的病例组分为两类：护士主导的诊所和护士主导的处方。护士主导的诊所在医生提供的标准糖尿病护理基础上实施，对照组仅接受标准糖尿病护理但无护士主导的诊所服务。上述医生可以单独工作或在医疗团队中工作。护士主导的处方由护士独立开具，并与医生开具的处方进行比较。
荟萃分析表明，与标准糖尿病护理相比，护士主导的诊所显著降低了HbA1c水平（标准均差[SMD]= -0.767；95%置信区间[CI]：-1.062，-0.471；P<0.001）。在亚组分析中，无论在发达国家（SMD= -0.353；95%CI：-0.6，-0.106；P=0.005）还是发展中国家（SMD= -1.114；95%CI：-1.498，-0.73；P<0.001），护士主导的诊所对控制HbA1c水平均有积极影响。此外，在控制HbA1c水平方面，护士主导的处方与医生处方之间无显著差异（SMD= -0.203；95%CI：-0.434，0.029；P=0.086）。
护士主导的诊所对HbA1c控制具有积极意义。同时，护士主导的处方对控制HbA1c的影响与医生相当。在医生提供的标准糖尿病护理基础上提供护士主导的诊所服务对更好地控制HbA1c具有重要价值，在医生主导服务受限的情况下应提供护士主导的处方。
