5. Utilisation outcomes.
| Study | Number, length, and frequency of consultations | Numbers of prescriptions, tests, and investigations | Use of other services |
| Dierick‐van Daele 2009 | Referrals: nurse 12%, doctor 14.2%, P = 0.24a | ||
| Hemani 1999 |
Compared to qualified doctors Consultation rate: Nurses 3.52 vs qualified doctors 4.03 (P > 0.05) Compared to residents (trainee doctors) Consultation rate: Nurses 3.52 vs residents 2.95 (P < 0.05) |
Mean utilisation rate: Compared to qualified doctors Tests & investigations: Lab tests: NP 32.67, doctor 29.46, P > 0.05 Radiological tests (total): NP 1.68. doctor 1.37, P > 0.05 ‐ CT/MRI: NP 0.32, doctor 0.13, P < 0.05 ‐ Ultrasound: NP 0.16, doctor 0.07, P < 0.05 Compared to residents (trainee doctors) Tests & investigations: Lab tests: NP 32.67, doctor 28.26, P > 0.05 ‐ Urinalysis: NP 1.31, doctor 0.99, P < 0.05 ‐ Thyroid function: NP 0.37, doctor 0.19, P < 0.05 Radiological tests: NP 1.68, doctor 1.48, P > 0.05 |
Mean utilisation rate: Compared to qualified doctors Hospital admission: NP 0.43, doctor 0.33, P > 0.05 Emergency room visits: NP 1.22, doctor 1.23, P > 0.05 Specialty visits: NP 5.35, doctor 4.26, P > 0.05 Compared to residents (trainee doctors) Hospital admission: NP 0.43, doctor 0.31, P > 0.05 Emergency department visits: NP 1.22, doctor 1.05, P > 0.05 Specialty visits: NP 5.35, doctor 4.21, P > 0.05 |
| Houweling 2011 |
Mean number of visits: nurse 6.1, GP 2.8 (P < 0.0001) Total duration of visits: significantly higher in nurse groupa Consultation of nurses' patients with GP: Median number of these consultations per patient was 1.4 (25 to 75 quartiles: 0.0 to 2.0) with median time of 1.0 (25 to 75 quartiles: 0.0 to 3.3) minute |
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| Iglesias 2013 |
Level of resolution by nurses: Nurses led 86.3% (95% CI 83.6 to 88.7) of consultations without referral to GP (referrals according to protocol indication not included) |
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| Larsson 2014 |
Proportion nurse‐led vs doctor‐led: ‐ Cortisone injections in addition to regular rheumatologist monitoring visits (1:0.7; P = 0.463) ‐ Blood tests (1:3.9; P = 0.014) ‐ Radiography (1:1.6; P = 0.162) ‐ Pharmacological therapy (1:1.1; P = 0.029) |
Proportion nurse‐led vs doctor‐led: ‐ Additional telephone calls to a rheumatology nurse (1:1.8; P = 0.060) ‐ Additional telephone calls to a rheumatologist (1:1.9; P =0.287) ‐ Additional rheumatologist visits (1:2.4; P = 0.077) ‐ Team rehabilitation in in‐patient settings (0:79; P = 0.086) ‐ Team rehabilitation in out‐patient settings (15:0; P = 0.135) ‐ Occupational therapist treatments (0:3.0; P = 0.162) ‐ Psychosocial treatments (0:1.0; P = 0.152) ‐ Specialist consultations (1:1.0; P = 0.949) |
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| Lattimer 1998 |
Impact on GP workload: ‐ Telephone advice from GP: fewer with nurse‐led care, 35% reductionb ‐ Surgery visits: 10% fewer with nurse‐led careb ‐ Home visits: 6% fewer home visits during intervention periodb |
Hospital admission within 24 hours: nurse 2%, GP 6.5%, RR 0.31 (95% CI 0.07 to 1.42) Hospital admission within 3 days: nurse 5%, GP 6.5%, RR 0.77 (95% CI 0.26 to 2.28) Emergency department visit: nurse 3%, GP 2%, RR 1.84 (95% CI 0.31 to 10.82) |
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| Lewis 1967 |
Consultation length: doctor 15 minutes, nurse 30 minutesc Consultation rate: doctor 150 visits, nurse 345 visitsc |
Days in hospital: doctor 68 days, nurse 45 daysc | |
| Moher 2001 |
Prescriptions: ‐ Antihypertensives: no difference, P = 0.35a ‐ Lipid lowering: no difference, P = 0.63a ‐ Antiplatelet: nurse 8% (95% CI 1% to 9%) more than GP (P = 0.031) |
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| Mundinger 2000 | Consultation rate: Doctor patients had higher primary care utilisation than nurse practitioner patients (2.50 vs 1.76 visits, P = 0.05) | Speciality visits: no differenced, P = 0.61 | |
| Ndosi 2013 |
Consultation length: Mean total consultation time: nurse 111 min, doctor 71 mina,b Consultation rate: Patients attending all 5 sessions: nurse 92%, doctor 85%a,b |
‐ Change in medicines: nurse < doctor; RR (95% CI) 0.58 (0.43 to 0.79), P = 0.0006 ‐ Dosage changes: nurse < doctor; RR (95% CI) 0.52 (0.34 to 0.79), P = 0.0020 ‐ Intra‐articular injections: nurse < doctor; RR (95% CI) 0.82 (0.50 to 1.35), P = 0.4400 ‐ Intramusclar injections: nurse < doctor; RR (95% CI) 0.73 (0.45 to 1.19), P = 0.2100 ‐ Non‐protocol bloods: nurse < doctor; RR (95% CI) 1.02 (0.74 to 1.40), P = 0.9100 |
‐ Referral to physiotherapy: nurse < doctor; RR (95% CI) 1.21 (0.62 to 2.39), P = 0.5800 ‐ Referral to occupational therapy: nurse < doctor; RR (95% CI) 1.74 (0.76 to 3.96), P = 0.1900 ‐ Referral to podiatry: nurse < doctor; RR (95% CI) 0.89 (0.37 to 2.14), P = 0.8000 ‐ Conferrals: nurse < doctor; RR (95% CI) 2.92 (1.77 to 4.83), P < 0.0001 ‐ Referral to other consultants: nurse < doctor; RR (95% CI) 0.58 (0.11 to 3.11), P = 0.5200 |
| Shum 2000 | Out‐of‐hours calls: nurse 0.9% vs GP 1.8%, P = 0.218 | ||
| Venning 2000 | Physical examinations: nurse vs GP; MD 0.19 (95% CI ‐0.03 to 0.71), P = 0.072 | ||
| Voogdt‐Pruis 2010 |
Referred to professional nurse vs doctor: ‐ Dietician 17.0 vs 8.9b ‐ Physiotherapist 3.1 vs 1.9b ‐ Cardiovascular specialist 1.9 vs 6.3b ‐ Visited a cardiovascular specialist 46.3 vs 45.3 (0.84 to 1.79; P = 0.30) ‐ Admission into hospital because of CVD 10.4 vs 13.4 (0.43 to 1.38; P = 0.38) |
aTrial authors reported no effect size or reported effect sizes in graphs (no exact effect sizes extracted).
bNo P value reported.
cTrial authors reported only the direction of the outcome; it remains unknown whether the difference is statistically significant.
dToo many numbers to report.
CI: confidence interval.
CT: computed tomography.
CVD: cardiovascular disease.
GP: general practitioner.
MRI: magnetic resonance imaging.
NP: nurse practitioner.
RR: risk ratio.
*there may be additional data in the Campbell 2014 articles that have not been extracted