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Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis

Author

Listed:
  • Azzurra Massimi
  • Corrado De Vito
  • Ilaria Brufola
  • Alice Corsaro
  • Carolina Marzuillo
  • Giuseppe Migliara
  • Maria Luisa Rega
  • Walter Ricciardi
  • Paolo Villari
  • Gianfranco Damiani

Abstract

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies—3,881 patients) and HbA1c reduction (7 studies—2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01—-1.06), DBP -1.42 (95% CI -1.42—-0.49) and HbA1c -0.15 (95% CI -0.32–0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.

Suggested Citation

  • Azzurra Massimi & Corrado De Vito & Ilaria Brufola & Alice Corsaro & Carolina Marzuillo & Giuseppe Migliara & Maria Luisa Rega & Walter Ricciardi & Paolo Villari & Gianfranco Damiani, 2017. "Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-22, March.
    • Handle: RePEc:plo:pone00:0173617
    DOI: 10.1371/journal.pone.0173617
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    Cited by:

    1. Denise Nana Pleh & Elizabeth Rosted & Thora Grothe Thomsen, 2021. "Key competences of outpatient nurses, as perceived by patients attending nurse‐led clinics – An integrative review," Journal of Clinical Nursing, John Wiley & Sons, vol. 30(3-4), pages 311-322, February.
    2. Vincenzo Gianturco & Luigi Gianturco & Rebecca Regnoli & Bruno Dino Bodini & Maurizio Turiel & Martino Trapani & Francesco Bini & Giuseppe De Angelis, 2020. "Healthy Promotion for Fighting Metabolic Syndrome: Insights from Multi-Center HeRO-FiT Cohort," IJERPH, MDPI, vol. 17(15), pages 1-10, July.
    3. Jeonghyun Cho & Kyungin Jeong & Samsook Kim & Hyejin Kim, 2019. "Exploring the Healthcare Seeking Behavior of Medical Aid Beneficiaries Who Overutilize Healthcare Services: A Qualitative Descriptive Study," IJERPH, MDPI, vol. 16(14), pages 1-9, July.
    4. Carles Vilaplana-Carnerero & Ignacio Aznar-Lou & María Teresa Peñarrubia-María & Antoni Serrano-Blanco & Rita Fernández-Vergel & Dolors Petitbò-Antúnez & Montserrat Gil-Girbau & Marian March-Pujol & J, 2020. "Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors," IJERPH, MDPI, vol. 17(10), pages 1-17, May.
    5. Chiara Pazzaglia & Claudia Camedda & Nikita Valentina Ugenti & Andrea Trentin & Sandra Scalorbi & Yari Longobucco, 2023. "Community Health Assessment Tools Adoptable in Nursing Practice: A Scoping Review," IJERPH, MDPI, vol. 20(3), pages 1-44, January.
    6. Brigitte Woo & Karen Koh & Wentao Zhou & Toon Wei Lim & Violeta Lopez & Wilson Tam, 2020. "Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(9-10), pages 1623-1634, May.
    7. Timmermans, Lotte & Golder, Elena & Decat, Peter & Foulon, Veerle & Van Hecke, Ann & Schoenmakers, Birgitte, 2023. "Characteristics of self-management support (SMS) interventions and their impact on Quality of Life (QoL) in adults with chronic diseases: An umbrella review of systematic reviews," Health Policy, Elsevier, vol. 135(C).

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