Nurse-managed protocols in the outpatient setting have consistently positive effects on adult patients with chronic disease, according to a meta-analysis of studies involving more than 23,000 patients.
In 18 studies in which a registered nurse or equivalent titrated medications for diabetes, hypertension, and hyperlipidemia by using a protocol, hemoglobin A1c levels decreased by a mean of 0.4%; systolic and diastolic blood pressure decreased by a mean of 3.68 mm Hg and 1.56 mm Hg, respectively; total cholesterol levels decreased by a mean of 0.24 mmol/L; and low-density lipoprotein cholesterol levels decreased by a mean of 0.31 mmol/L, compared with usual care, Ryan J. Shaw, Ph.D., of Duke University School of Nursing, Durham, N.C. and his colleagues reported online July 14 in Annals of Internal Medicine.
The findings suggest that a team approach involving nurse-managed protocols could be helpful for managing the increasing numbers of patients with chronic conditions who are expected to enter the health care system, the investigators said (Ann. Intern. Med. 2014 July 14 [doi:10.7326/M13-2567]).
"With changes in federal health policy, new models are needed to provide more accessible and effective chronic disease care. ... Our review shows that team approaches using nurse-managed protocols help improve health outcomes among patients with moderately severe diabetes, hypertension, and hyperlipidemia," they concluded, noting that "further research is needed to understand the effects of nurse-managed protocols in caring for complex or unstable patients."
This study was funded by the Department of Veterans Affairs.