Shaw, R. J. and McDuffie, J. R. and Hendrix, C. C. and Nagi, A. and Edie, A. and Lindsey-Davis, L. and Williams, J. W. Jr., A Systematic Review: Effects of Nurse-Managed Protocols in the Outpatient Management of Adults with Chronic Illness. (VA-ESP Project #09-010)
(August, 2013), VA Health Services Research and Development
(last updated on 2014/04/03)
Abstract:
Medical management of chronic illness consumes 75% of every healthcare dollar spent in the United States; thus, the provision of economical and accessible, yet high-quality care is a major concern. Diabetes, hypertension, hyperlipidemia, and cardiovascular disease are prime examples of chronic diseases that cause substantial morbidity and mortality, and require long-term medical management. VA is developing protocols and policies that expand the nurse's role as a member of Patient Aligned Care Teams (PACTs) as one strategy to address the need to improve the management of these chronic illnesses. A protocol includes a series of actions set by current clinical guidelines or standards of practice that are implemented by nurses to manage a patient's condition.
The VA Evidence-Based Synthesis Program located in Durham, NC conducted a systematic review of the literature to describe the effects of nurse-managed protocols for the outpatient management of adults with high-impact, chronic conditions, such as type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure (CHF). Investigators conducted a review of the literature from January 1, 1980 through December 12, 2012 for peer-reviewed publications that evaluated interventions using nurse-managed protocols compared with usual care in studies targeting adults with the aforementioned conditions. This evidence report is based on 31 articles, reporting on 29 unique studies (26 were randomized controlled trials). Results are presented in the Summary, which is followed by three key questions that provide more detailed information.
* Summary
Results from this systematic review and meta-analysis suggest that nurse-managed protocols have positive effects on the outpatient management of adults with moderate severity of type 2 diabetes, hypertension, hyperlipidemia, and CHF. The most robust finding is that nurse-managed protocols had a positive impact on the biophysical outcomes of chronically ill patients (e.g., decrease in mortality and fewer hospitalizations for CHF patients). Additionally, interventions delivered by telephone demonstrated greater effects for total and LDL cholesterol. There was insufficient evidence to determine fidelity to treatment protocols or adverse events associated with nurse-managed protocols.
