An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?

Matthys, Evi; Remmen, Roy; Van Bogaert, Peter

doi:10.1186/s12875-017-0698-x

Table 3 Meta-analyses (n = 4)

From: An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?

Aubin et al., 2012
Intervention	Control	Outcome	Number of studies	Number of patients	Median effect size^a % (95% BCI)^b	Hetero-geneity	Quality of evidence: GRADE
Interdisciplinary teams (targeting informational continuity)	Usual care	Functional status	11	3057	0 (−3.40, 2.70)	NAV	Very low
		Physical status	16	3589	0 (−0.50, 0.50)	NAV	Very low
		Psychological status	13	3228	−0.24 (−3.00, 0.02)	NAV	Very low
		Social status	4	589	−0.01 (−10.70, 0.30)	NAV	Very low
		Global quality of life	9	2472	2.0 (−0.03, 3.20)	NAV	Very low
Interdisciplinary teams (targeting management continuity)	Usual care	Functional status	11	2612	0 (−3.40, 2.00)	NAV	Very low
		Physical status	18	3439	0 (−0.50, 0.03)	NAV	Very low
		Psychological status	15	3687	−1.1 (−6.30, 0.00)	NAV	Very low
		Social status	4	528	−0.7 (−7.00, 0.30)	NAV	Very low
		Global quality of life	7	1717	2.0 (−1.90, 3.20)	NAV	Very low
Health Quality Ontario, 2014
Intervention	Control	Outcome	Number of studies	Number of patients	Effect size (95% CI)	Hetero-geneity	Quality of evidence: GRADE
Home team-based model of care	Medicare guidelines for home health care	Home death (number of people)	1	310	Odds ratio 2.20 (1.30, 3.72)	NA	Low
Home team-based model of care	Medicare guidelines for home health care	Hospital admission (number of people admitted to hospital)	1	310	Odds ratio 0.39 (0.24, 0.62)	NA	Low
Home (indirect) team-based model of care	Usual care by a management care organization	Advanced care planning (number of people)	1	190	Odds ratio 1.30 (0.58, 2.90)	NA	Very low
Hospital team-based model of care	Hospital care/primary care team only	Advanced care planning	2	616	Odds ratio 2.77 (0.48, 16.11)	I-square 48%	Very low
Comprehensive team-based model of care	Usual care	Home death (number of people)	1	434	Odds ratio 1.89 (1.13, 3.16)	NA	Moderate
		Nursing home death (number of people)	1	434	Odds ratio 0.37 (0.20, 0.67)	NA	Moderate
		Hospital admission	1	434	Odds ratio 0.90 (0.42, 1.89)	NA	Moderate
Comprehensive, early start, team-based model of care	Routine oncologic care	Hospital admission	1	151	Odds ratio 0.84 (0.34, 2.03)	NA	Low
Shaw et al., 2014
Intervention	Control	Outcome	Number of studies	Number of patients	Effect size (95% CI)	Hetero-geneity	Quality of evidence- risk of bias
Nurse-managed protocols	Usual care	Systolic blood pressure (difference in mmHg)	12	Intervention:5244 Control:4980	Weighted mean difference − 3.68 (−6.31, −1.05)	I-square 75.1%	According to the approach recommended by the Agency for Healthcare Research and Quality: 4 articles: Low risk of bias/good quality 12 articles: Moderate risk of bias/fair quality 2 articles: High risk of bias/poor quality
	Usual care	Diastolic blood pressure (difference in mmHg)	12	Intervention:5244 Control:4980	Weighted mean difference − 1.56 (−2.76, −0.36)	I-square 75.1%
	Usual care	Total cholesterol (difference in mg/dL)	9	Intervention:1879 Control:1615	Weighted mean difference − 9.37 (−20.77, 2.02)	I-square 90.8%
	Usual care	Low-density lipoprotein cholesterol (difference in mg/dL)	6	Intervention:564 Control:555	Weighted mean difference − 12.07 (−28.27, 4.13)	I-square 89.1%
	Usual care	Hemoglobin A1c level	8	Intervention:1444 Control: 1189	Weighted mean difference − 0.40 (−0.70, −0.10)%	I-square 69.8%
Snaterse et al., 2016
Intervention	Control	Outcome	Number of studies	Number of patients	Effect size (95% CI)	Hetero-geneity	Quality of evidence– risk of bias
Nurse-coordinated care	Usual care	Blood pressure (difference in mmHg)	7	3514	Weighted mean difference −2.96 (−4.40, −1.53)	I-square 37.1% p = 0.146	Cochrane Collaboration’s risk of bias tool: low/unclear risk of bias.
	Usual care	Low-density lipoprotein cholesterol (difference in mmol/L)	8	3441	Weighted mean difference −0.23 (−0.36, −0.10)	I-square 74.3% p = 0.000
	Usual care	Smoking cessation rates (Relative risk of quitting)	8	3265	Relative risk 1.25 (1.09, 1.43)%	I-square 0.0% p = 0.459

Table 3 presents the results of the meta-analyses of four of the included systematic reviews. The different ‘collaboration interventions’ are presented, followed by the control group, patient outcomes, number of studies, number of patients, effect size, a measure of heterogeneity (if available) and a measure of quality of evidence/risk of bias (if available). The improved patient outcomes are written in bold
NA ‘not applicable’, NAV ‘not available’
^aTo handle the diverse set of outcomes within each individual study, the median value was computed of all the measured effects across all the outcomes of the same class. To pool the results from multiple studies, the median effect size was calculated for each class of outcome, by computing the median from all the median effects in outcomes obtained from individual studies. The researchers chose this pooling strategy to be consistent with the median approach used in other reviews [45,46,47]
^bnon-parametric bootstrap confidence intervals

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