PDF(Pubmed)
Abstract：
UNASSIGNED: To evaluate the effectiveness of the role of advanced nurse practitioners compared to physicians-led/ usual care (care managed by medical doctors or non-advanced nurse practitioners).
UNASSIGNED: Advanced nurse practitioners contribute to the improvement of quality patient care and have substantial potential to optimise the health of people globally. Since the formal recognition of advanced nurse practitioners by the International Council of Nurses, among others, the role has been adopted across most departments and clinical specialties, particularly in high-income countries.
UNASSIGNED: Systematic review of primary research evidence.
UNASSIGNED: MEDLINE, EMBASE, CINAHL, Cochrane registry, Cochrane trials, and Cochrane EPOC (PDQ Evidence) were searched for randomised controlled trials (RCTs) of patient care and health resource utilisation outcomes associated with advanced nurse practitioners.
UNASSIGNED: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The chosen articles were restricted to full-text English language trials published in the last 20 years, incorporating comparators of usual care. Search terms were limited to variations of advanced nurse practitioner role and practice. The eligible studies were bias risk assessed and quality assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Clinical and service outcomes were analysed using narrative synthesis as the marked heterogeneity between studies precluded meta-analysis.
UNASSIGNED: Thirteen RCTs were reviewed. All of them were conducted across high-income countries within primary care and hospital settings involving paediatric and adult patients. Five trials were assessed as high quality, and eight were of low to moderate quality. Positive effects were demonstrated for the impact of advanced nurse practitioners on usual care; for indigestion, mean difference [MD] 2.3: 95% CI 1.4, 3.1]), perceptions of health status [ (MD -140.6; 95% CI -184.8, -96.5)], satisfaction levels [ (MD ranged from -8.79; 95% CI -13.59, -3.98 to 0.61; 95% CI -4.84, 6.05)], physical function (1.58 [SD 0.76] v. 1.81 [SD 0.90]), and blood pressure control (systolic [133 [SD 21] v. 135 [SD 19] mmHg p = 0.04] and diastolic [77 [SD 10] v. 80 [SD 11] mmHg p = 0.007]) were looked at. Positive effects related to service provision included improved patient satisfaction and reductions in waiting times and costs, which significantly favored advanced nurse practitioners (all p < 0.05).
UNASSIGNED: The evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations.
UNASSIGNED: Advanced nurse practitioners contribute to the improvement of quality patient care and have substantial potential to optimise the health of people globally. Since the formal recognition of advanced nurse practitioners by the International Council of Nurses, among others, the role has been adopted across most departments and clinical specialties, particularly in high-income countries.
UNASSIGNED: Systematic review of primary research evidence.
UNASSIGNED: MEDLINE, EMBASE, CINAHL, Cochrane registry, Cochrane trials, and Cochrane EPOC (PDQ Evidence) were searched for randomised controlled trials (RCTs) of patient care and health resource utilisation outcomes associated with advanced nurse practitioners.
UNASSIGNED: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The chosen articles were restricted to full-text English language trials published in the last 20 years, incorporating comparators of usual care. Search terms were limited to variations of advanced nurse practitioner role and practice. The eligible studies were bias risk assessed and quality assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Clinical and service outcomes were analysed using narrative synthesis as the marked heterogeneity between studies precluded meta-analysis.
UNASSIGNED: Thirteen RCTs were reviewed. All of them were conducted across high-income countries within primary care and hospital settings involving paediatric and adult patients. Five trials were assessed as high quality, and eight were of low to moderate quality. Positive effects were demonstrated for the impact of advanced nurse practitioners on usual care; for indigestion, mean difference [MD] 2.3: 95% CI 1.4, 3.1]), perceptions of health status [ (MD -140.6; 95% CI -184.8, -96.5)], satisfaction levels [ (MD ranged from -8.79; 95% CI -13.59, -3.98 to 0.61; 95% CI -4.84, 6.05)], physical function (1.58 [SD 0.76] v. 1.81 [SD 0.90]), and blood pressure control (systolic [133 [SD 21] v. 135 [SD 19] mmHg p = 0.04] and diastolic [77 [SD 10] v. 80 [SD 11] mmHg p = 0.007]) were looked at. Positive effects related to service provision included improved patient satisfaction and reductions in waiting times and costs, which significantly favored advanced nurse practitioners (all p < 0.05).
UNASSIGNED: The evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations.
摘要：
■评估高级执业护士与医师主导/常规护理（由医生或非高级执业护士管理的护理）相比的作用的有效性。
■高级执业护士为改善患者护理质量做出了贡献，并具有优化全球人群健康的巨大潜力。自从国际护士理事会正式认可高级执业护士以来，其中,这一角色已被大多数科室和临床专科采用，特别是在高收入国家。
■主要研究证据的系统评价。
■MEDLINE,EMBASE,CINAHL,Cochrane登记处,Cochrane试验,我们在CochraneEPOC(PDQEvidence)中搜索了与高级执业护士相关的患者护理和卫生资源利用结局的随机对照试验(RCT).
■审查是根据系统审查和荟萃分析（PRISMA）声明的首选报告项目进行的。选择的文章仅限于过去20年发表的全文英语语言试验，纳入常规护理比较器。搜索词仅限于高级护士从业者角色和实践的变化。符合条件的研究采用建议分级进行偏倚风险评估和质量评估，评估,开发和评估（等级）。使用叙述性综合分析临床和服务结果，因为研究之间的明显异质性排除了荟萃分析。
■对13项随机对照试验进行了综述。所有这些都是在高收入国家的初级保健和医院环境中进行的，涉及儿科和成年患者。五项试验被评估为高质量，八个质量低到中等。高级护士从业人员对日常护理的影响表现出积极作用；对于消化不良，平均差异[MD]2.3：95%CI1.4，3.1])，对健康状况的看法[(MD-140.6；95%CI-184.8，-96.5)]，满意度[（MD范围为-8.79；95％CI-13.59，-3.98至0.61；95％CI-4.84，6.05）]，物理功能(1.58[SD0.76]v.1.81[SD0.90])，观察血压控制（收缩压[133[SD21]v.135[SD19]mmHgp=0.04]和舒张压[77[SD10]v.80[SD11]mmHgp=0.007]）。与服务提供相关的积极影响包括提高患者满意度，减少等待时间和成本，显着有利于高级护士从业人员（所有p<0.05）。
■本综述的证据支持高级执业护士对临床和服务相关结果的积极影响：患者满意度，等待时间,控制慢性病，和成本效益，特别是当直接与医生主导的护理和常规护理实践相比时-在初级，涉及成人和儿科人群的二级和专科护理设置。
■高级执业护士为改善患者护理质量做出了贡献，并具有优化全球人群健康的巨大潜力。自从国际护士理事会正式认可高级执业护士以来，其中,这一角色已被大多数科室和临床专科采用，特别是在高收入国家。
■主要研究证据的系统评价。
■MEDLINE,EMBASE,CINAHL,Cochrane登记处,Cochrane试验,我们在CochraneEPOC(PDQEvidence)中搜索了与高级执业护士相关的患者护理和卫生资源利用结局的随机对照试验(RCT).
■审查是根据系统审查和荟萃分析（PRISMA）声明的首选报告项目进行的。选择的文章仅限于过去20年发表的全文英语语言试验，纳入常规护理比较器。搜索词仅限于高级护士从业者角色和实践的变化。符合条件的研究采用建议分级进行偏倚风险评估和质量评估，评估,开发和评估（等级）。使用叙述性综合分析临床和服务结果，因为研究之间的明显异质性排除了荟萃分析。
■对13项随机对照试验进行了综述。所有这些都是在高收入国家的初级保健和医院环境中进行的，涉及儿科和成年患者。五项试验被评估为高质量，八个质量低到中等。高级护士从业人员对日常护理的影响表现出积极作用；对于消化不良，平均差异[MD]2.3：95%CI1.4，3.1])，对健康状况的看法[(MD-140.6；95%CI-184.8，-96.5)]，满意度[（MD范围为-8.79；95％CI-13.59，-3.98至0.61；95％CI-4.84，6.05）]，物理功能(1.58[SD0.76]v.1.81[SD0.90])，观察血压控制（收缩压[133[SD21]v.135[SD19]mmHgp=0.04]和舒张压[77[SD10]v.80[SD11]mmHgp=0.007]）。与服务提供相关的积极影响包括提高患者满意度，减少等待时间和成本，显着有利于高级护士从业人员（所有p<0.05）。
■本综述的证据支持高级执业护士对临床和服务相关结果的积极影响：患者满意度，等待时间,控制慢性病，和成本效益，特别是当直接与医生主导的护理和常规护理实践相比时-在初级，涉及成人和儿科人群的二级和专科护理设置。
