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. 2018 Jul 16;2018(7):CD001271. doi: 10.1002/14651858.CD001271.pub3

Lewis 1967.

Methods Randomised trial
Participants 66 patients (total group), 16+ years, 12% male
 Unknown numbers of nurses and doctors
Interventions Intervention: patients allocated to nurse‐led care
 Control: patients allocated to doctor‐led care
Detailed description of the intervention:
Compared 2 groups delivering care to patients with chronic illnesses:
  • Nurse clinic: nurses as the primary source of care for adults with chronic illnesses (i.e. hypertensive cardiovascular disease; arteriosclerotic heart disease; exogenous obesity; psychophysiological reactions; and arthritis)

  • Control: medicine clinic


Supervision, oversight: unknown
Outcomes Patient outcomes:
  • Health status

  • Provider preference

  • Compliance with follow‐up attendance


Resource utilisation:
  • Direct costs

Notes Country: USA
Study period: 12 months
Nurse role: ongoing primary care for patients with stable chronic disease
Nurse title: not clear
Nurse educational background: EQF level unknown
Nurse years of experience: unknown
Nurse additional training: unknown
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk No information
Allocation concealment (selection bias) Unclear risk No information
Baseline characteristics Low risk Baseline characteristics were reported and were similar for both groups.
 "There were no differences among the scores of the two groups on initial testing".
Baseline outcome measurement Low risk Baseline outcomes were reported and were similar for both groups.
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Not performed
 It is unclear whether the outcome was influenced by lack of blinding of patients and care providers.
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk No information
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Follow‐up of patients > 80%
Selective reporting (reporting bias) Unclear risk The protocol was not available.
Contamination High risk Potential contamination represented by cross‐over of patients/clinicians between groups
"On 95% of these occasions, patients were seen by the nurse alone".
Bias due to lack of power Unclear risk No power calculation performed