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Table 3 Effect estimates of studies in review

From: The impact of physician–nurse task shifting in primary care on the course of disease: a systematic review

Study

Nurses’ role

Population diagnosis

Outcome

Measurement method/scale

FUP, months

Nurse group

Physician group

Effect estimate

First author, y

Location

Binary data

 

n

N

n

N

RR (95 % CI)

 Heart disease

  Andryukhin et al., 2011 [18]

RU 1

NP/LN

Heart failure PEF

Positiveb changes in class HF

NYHA

6

18

40

8

35

1.97 (0.98 to 3.96)

  Campbell et al., 1998 [1921, 2931, 33]

UK 1

NP

CHD secondary prevention

Chest pain

ATyPeS/SF36a

12

232

508

250

498

0.91 (0.80 to 1.04)

  Campbell et al., 1998 [1921, 2931, 33]

UK 1

NP

CHD secondary prevention

Chest pain

ATyPeS/SF36

48

147

430

129

385

1.02 (0.84 to 1.24)

  Campbell et al., 1998 [1921, 2931, 33]

UK 1

NP

CHD secondary prevention

Worsening chest pain

ATyPeS/SF36

12

37

519

54

500

0.66 (0.44 to 0.98)

  Campbell et al., 1998 [1921, 2931, 33]

UK 1

NP

CHD secondary prevention

Worsening chest pain

ATyPeS/SF36

48

44

439

35

395

1.13 (0.74 to 1.73)

 Lung disease

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

No chronic cough and phlegm production or an improvement

Present/absent

12

43

108

39

85

0.87 (0.63 to 1.20)

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

No chronic cough and phlegm production or an improvement

Present/absent

24

41

93

33

79

1.06 (0.75 to 1.49)

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

No wheezing or an improvement in frequency

Never, ever, most days and night

12

68

106

51

85

1.07 (0.85 to 1.34)

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

No wheezing or an improvement in frequency

Never, ever, most days and night

24

53

93

37

79

1.22 (0.91 to 1.63)

 Infectious disease

  Fairall et al., 2012 [25]

ZA 2

LN

HIV/AIDS

Suppressed viral load in patients receiving ARTd

Viral load

12–18

2156

3029

2230

3202

1.02 (0.99 to 1.06)

  Fairall et al., 2012 [25]

ZA 1

LN

HIV/AIDS

Suppressed viral load in patients starting ARTd

Viral load

12–18

1706

2375

1062

1449

0.98 (0.94 to 1.02)

 Diverse, acute and minor conditions

  Shum et al., 2000 [32]

UK 2

NP

Acute and minor

Same, improved or cured self-reported health status

Murphy

0.5

650

672

646

661

0.99 (0.97 to 1.01)

  Kinnersley et al., 2000 [34]

UK 3

NP

Diverse conditions

Same or improved symptoms (much better, better or unchanged)

Likert-type and single reminders

0.5

472

484

515

529

1.00 (0.98 to 1.02)

Continuous data

Mean (SD)

N

Mean (SD)

N

WMD (95 % CI)

 Lung disease

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

Mean change score in dyspnea

MRCQTc

12

0.00 (1.3)

115

0.10 (1.3)

94

−0.10 (−0.45 to 0.25)

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

Mean change score in dyspnea

MRCQTc

24

0.20 (1.4)

96

0.30 (1.3)

80

−0.10 (−0.50 to 0.30)

 Metabolic disease

  Denver et al., 2003 [23]

UK 5

NP+

DM2 with hypertension, under BPLT

Mean fall in 10-year CHD risk

Framingham CHD risk score

6

−2.33 (3.87)

59

−0.33 (2.16)

56

−2.00 (−3.14 to −0.86)

  Denver et al., 2003 [23]

UK 5

NP+

DM2 with hypertension, under BPLT

Mean fall in 10-year stroke risk

Framingham stroke risk score

6

−4.33 (6.0)

59

−1.80 (3.53)

56

−2.53 (−4.32 to −0.74)

 Digestive disease

  Chan et al., 2009 [22]

UK 6

NP+

GORD, moderate gastritis

Mean score, dyspepsia severity

GDSS (Gladys) scoreg

6

4.90 (2.9)

89

7.20 (3.1)

86

−2.30 (−3.19 to −1.41)

 Skin disease

  Kernick et al., 2000 [28]

UK 4

NP+

Psoriasis/eczema

Mean score for symptoms and severity of skin condition

Self-evaluation clinical scoree

4

7.60 (3.3)

35

8.1 (3.3)

46

−0.50 (−1.95 to 0.95)

 Common complaints

  Dierick-van Daele et al., 2009 [24]

NL 2

NP+

Common complaints

Mean difference in the degree of burden of illness

LikertQTf

0.5

−1.77 (3.18)

473

−1.50 (2.63)

451

−0.27 (−0.65 to 0.11)

  Dierick-van Daele et al., 2009 [24]

NL 2

NP+

Common complaints

Mean difference in the concerns about illness

LikertQTf

0.5

−1.51 (3.20)

476

−1.40 (2.97)

450

−0.11 (−0.51 to 0.29)

Qualitative data

  

 Metabolic disease

  

  Houweling et al., 2011 [27]

NL 3

NP

DM2

Perceived burden of DM symptoms and rating of symptom troublesomeness

Type 2 Diabetes Symptom Checklisth

14

“significant differences at follow-up for some of the Diabetes Symptom Score dimensions (data not shown). After 14 months, the mean sub-dimension scores for DM symptoms ‘fatigue’ and ‘cognitive distress’ and the total scores were lower in each group, although no difference was observed between the groups.”

 Lung disease

  Hesselink et al., 2004 [26]

NL 1

LN

Asthma/COPD

Respiratory complaints within two weeks after intervention

Disturbance (present/absent) for >1 day or night

0.5

“no significant group differences in the number of days or nights disturbed, OR 0.96 (95 % CI 0.56 to 1.61)”

 Common complaints

  Dierick-van Daele et al., 2009 [24]

NL 2

NP+

Common complaints

Complications due to illness

Mean number of days of work absence

0.5

“1.11 days (nurse, SD 0.32; physician, SD 0.31) of work absence in average”

  Dierick-van Daele et al., 2009 [24]

NL 2

NP+

Common complaints

Complications due illness

Mean number of days of inability for daily activities

0.5

“no statistically significant differences between groups; mean days unable for daily activities: nurse-led care 2.53 (SD 2.89), physician-led care 2.69 (SD 2.90)”

  1. Studies are listed in order of increasing length of follow-up, within each category of outcomes
  2. UK: United Kingdom; NL: the Netherlands; ZA: South Africa; RU: Russia; n: number of patients or number of events; N: total number of patients per group; SD: standard deviation; RR: relative risk; WMD: weighted mean difference; CI: confidence intervals; DM(2): diabetes mellitus (type 2); GORD: gastro-esophageal reflux disease; COPD: chronic obstructive pulmonary disease; CHD: coronary heart disease; BPLT: blood pressure lowering treatment; PEF: preserved ejection fraction; MRCQT: Medical Research Council Questionnaire; LikertQT: Likert-type questionnaire; GDSS: Glasgow Dyspepsia Severity Score (Gladys); NYHA: New York Heart Association Functional Classification; ATyPeS: Angina TyPe specification scale
  3. aATyPeS is designed to use with the SF36 questionnaire to assess the presence, frequency and course of chest pain
  4. bPositive changes mean regression of class or stay within class I of NYHA
  5. cMRCQT ranking from 0 (no dyspnea) to 4 (very serious); positive mean values in each group indicate improvement; mean differences with negative values mean a reduction or improvement
  6. dZA1 trial: patients starting ART whose results were available for at least 6 months. ZA2 trial: 76 % and 78 % of the patients in the intervention and control group, respectively, had been receiving ART for at least 2 years at the time of viral load measurements
  7. eThree out of eight possible symptoms, each ranked from 1 (mild) to 5 (very severe). The sum score gave a clinical score from 3 (best state) to 15 (worst)
  8. fLikert-type questionnaire ranking from 0 (excellent) to 10 (poor/worse); mean differences with negative values mean a reduction or improvement
  9. gGDSS (Gladys) ranking from 0 (no symptoms) to 20 (symptoms)
  10. h34-item scale based on yes/no questionnaires for perceived burden of symptoms including hyperglycemic, hypoglycemic, cardiac, neuropathic, psychological and vision-related. Summary responses ranked from 1 (symptom not occurred or not perceived as troublesome) to 5 (symptom extremely troublesome) on Likert-type scale