4. Process of care outcomes.
Study | Provider care |
Campbell 2014 |
Difficulty with (nurse triage vs GP triage, MD (95% CI): Phone access: 6.49 (–1.26 to 14.25)a Receiving prompt care: 6.63 (3.23 to 10.03)a Seeing a doctor or nurse: 3.67 (–0.37 to 7.71)a Getting medical help: 5.09 (2.69 to 7.50)a Convenience of care 3.68 (1.13 to 6.24)a Problem resolution: nurse triage vs GP triage: 0.41 (–1.86 to 2.67)a Process indicators: ‐ Number of contacts per person: nurse vs GP triage: 1·04 (1·01 to 1·08)a ‐ 23% in the GP‐triage group and 12% in the nurse‐triage group had just 1 contact after their initial consultation requestb |
Dierick‐van Daele 2009 | Adherence to guidelines: nurse 79.8%, doctor 76.2%a,c |
Houweling 2011 |
Process indicators: ‐ Patients with last retina control > 24 months ago (n = 64) referred to an ophthalmologist: nurse 24/34 (70.6) vs GP 11/30 (36.7), P = 0.007 ‐ Patients with feet at‐risk (n = 109) for whom measures were taken: nurse 34/60 (56.7) vs GP 13/49 (26.5), P = 0.001 ‐ Patients referred to an internist to start insulin therapy: nurse 10/102 (9.8) vs GP 2/104 (1.9), P = 0.015 ‐ Patients with HbA1c ≥ 7 at baseline (n = 120), for whom glucose‐lowering therapy was intensified: nurse 53/64 (82.8) vs GP 28/56 (50.0), P = 0.001 ‐ Patients with BP > 140/90 at baseline (n = 170) for whom blood pressure‐lowering therapy was intensified: nurse 42/85 (49.4) vs GP 24/85 (28.2), P = 0.005 ‐ Patients not meeting target values for lipid profile at baseline (n = 55), for whom lipid‐lowering therapy was intensified: nurse 13/29 (44.8) vs GP 13/26 (50.0), P = 0.147 |
Moher 2001 |
Adequate assessment: ‐ Clinical assessment: nurse vs GP: 9% (95% CI ‐3 to 22), P = 0.13 ‐ Blood pressure: no differencec ‐ Cholesterol: no differencec ‐ Smoking status: no differencec |
Mundinger 2000 |
Documentation of provider behaviour diabetes care: ‐ Education (8 items): overall ‘any education’: nurse 84,9% vs medical doctor 42.4% (P < 0.001). With regard to specific items, nurse more education: 4 out of 7 topics: nutrition, weight, exercise, and medication (P < 0.01) ‐ History taken (5 items): no difference ‐ Monitoring (9 items): nurse ordered/carried out more laboratory tests, such as urinalysis (nurse 80.2%, medical doctor 55.9%, P < 0.01) and glycosylated haemoglobin (A1C value) (nurse 81.4, medical doctor 66.1, P < 0.05); nurse reported more frequently height of patients (nurse 91.9%, medical doctor 71.2%, P < 0.01). On other 6 items, no difference ‐ Referral (1 item): no differences |
Ndosi 2013 |
Interventions: ‐ Giving patient education: nurse > doctor; RR (95% CI) 1.76 (1.15 to 2.69), P = 0.009 ‐ Giving psychosocial support: nurse > doctor; RR (95% CI) 3.29 (2.55 to 4.24), P < 0.0001 |
Shum 2000 |
Provision of information: ‐ Self‐medication: nurse 22.2% vs GP 13.7%, P < 0.001 ‐ Self‐management: nurse 81.7% vs GP 57.6%, P < 0.001 |
Spitzer 1973 |
Adequate treatment: ‐ Drug treatment: nurses 71%, doctors 75%a ‐ Management of episodes: nurses 69%, doctors 66%a |
Voogdt‐Pruis 2010 |
Lifestyle and medical intervention nurse vs doctor: ‐ Smoking behaviour 8.2% vs 3.2%a ‐ Blood pressure 35.4% vs 26.6% (1.01 to 2.24; P = 0.04) ‐ Lipids 47.1 vs 22.3 (1.98 to 4.43; P < 0.01) ‐ Weight 36.9 vs 7.6 (4.26 to 12.52; P < 0.01) ‐ Exercise 19.4 vs 3.2a ‐ Food intake 14.6 vs 3.2a ‐ Medication 22.3 vs 14.7 (0.99 to 2.59; P = 0.05) ‐ None 22.8 vs 43.2 (1.69 to 3.86; P < 0.01) Asked about the use of medication: nurse vs doctor Group difference 2.12 (1.38 to 3.26; P < 0.01) ‐ Never 57.4 vs 75.4 ‐ Sometimes 20.0 vs 14.4 ‐ Often 22.1 vs 9.7 |
Venning 2000 | Examinations: nurse vs GP: MD 0.19 (95% CI ‐0.03 to 0.71), P = 0.072 |
aNo P value reported.
bTrial authors reported only the direction of the outcome; it remains unknown whether the difference is statistically significant.
cTrial authors reported no effect size or reported effect sizes in graphs (no exact effect sizes extracted).
CI: confidence interval.
GP: general practitioner.
MD: mean difference.
RR: risk ratio.
*there may be additional data in the Campbell 2014 articles that have not been extracted