Contribution of community-based nurse-led clinics to health care access and patient outcomes
Citation: Randall S, Crawford T, Currie J, et al. Impact of community-based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review. International Journal of Nursing Studies 2017; 73: 24-33.
Free to view: No
What is this? The COVID-19 pandemic is placing a strain on healthcare services. Community-based nurse-led clinics (NLC) may help increase patient access whilst maintaining quality of care.
In this systematic review, the authors searched for research literature related to community based NLCs. They did not restrict by type of publication and included peer-reviewed studies based in primary or community care settings, published in English between 2006 and 2016. They identified 15 studies (8 quantitative, including two randomised studies, 5 qualitative, and 3 mixed methods studies) including 3965 participants, which examined one or more of the following: patient outcomes, satisfaction, access and cost effectiveness.
What was found: There were high levels of patient satisfaction with NLCs. NLCs improve patient access to care as a result of community-based case management.
Most of the studies reviewed showed general improvement in various aspects of patient health.
Behavioural changes such as secondary health promotion and preventative practices (sex education leading to safer sex practices, and smoking cessation) were noted with NLCs.
Improvement in objective clinical outcomes such as ulcer healing time, improved body mass index in obese children, improved immunisation and management of upper respiratory tract infection was noted following services provided by NLCs.
There were mixed results for cost-effectiveness. There is some evidence that NLCs are cost-equivalent or cheaper than standard doctor-led services and can be cost-effective in terms of reduced hospital utilisation and readmission.
What doesn’t work: Nothing noted.
What’s uncertain: The full financial impact of NLCs has been insufficiently evaluated and hence is uncertain.
The most effective evaluation methods for community-based NLCs often lack rigor and, therefore, result in some degree of uncertainty.
The studies included in this review tended to present self-reported outcome data, with only three studies evaluating measurable patient outcomes.
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