Effects of Introducing a Specialized Nurse in the Care of Community-Dwelling Women Suffering From Urinary Incontinence

Moulin, Monique F. M. T. Du; Hamers, Jan P.H.; Paulus, Aneel; Berendsen, Chris L.; Halfens, Ruud

doi:10.1097/01.won.0000299814.98230.13

Cited by 20 publications

(26 citation statements)

References 52 publications

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“…The dropout rate in this observational study of (32 %) is high but comparable with other studies in which the drop-out rates vary from 11 % to 50 % [14, 15, 23]. …”

Section: Discussionsupporting

confidence: 87%

“…The improvement of UI after a nurse practitioner treatment is according to previous studies but the differences with our study are that these studies are conducted outside primary care practices [14–16, 23, 24]. Our results are also in line with a systematic review stating that nurse practitioners involved in the care of patients in general lead to an improvement of health outcomes and patients satisfaction [24].…”

Section: Discussionsupporting

confidence: 83%

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Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study

et al. 2015

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BackgroundUrinary Incontinence (UI) is a common problem in women. The management of UI in primary care is time consuming and suboptimal. Shift of incontinence-care from General Practitioners (GP’s) to a nurse practitioner maybe improves the quality of care. The purpose of this observational (pre/post) study is to determine the effectiveness of introducing a nurse practitioner in UI care and to explore women’s reasons for not completing treatment.MethodsSixteen trained nurse practitioners treated female patients with UI. All patients were examined and referred by the GP to the nurse practitioner working in the same practice. At baseline the severity of the UI (Sandvik-score), the impact on the quality of life (IIQ) and the impressed severity (PGIS) was measured and repeated after three months Differences were tested by the paired t and the NcNemar test.Reasons for not completing treatment were documented by the nurse practitioner and differences between the group that completed treatment and the drop-out group were tested.ResultsWe included 103 women, mean age 55 years (SD 12.6). The Sandvik severity categories improved significantly (P < 0.001), as did the impact on daily life (2.54 points, P = 0.012). Among the IIQ score the impact on daily activities increased 0.73 points (P = 0.032), on social functioning 0.60 points (P = 0.030) and on emotional well-being 0.63 points (P = 0.031). The PGIS-score improved in 41.3 % of the patients.The most important reasons for not completing the treatment were lack of improvement of the UI and difficulties in performing the exercises. Women who withdraw from guidance by the nurse practitioner perceived more impact on daily life (P = 0.036), in particular on the scores for social functioning (P = 0.015) and emotional well-being (P = 0.015).ConclusionTreatment by a trained nurse practitioner seems positively affects the severity of the UI and the impact on the quality of life. Women who did not complete treatment suffer from more impact on quality of life, experience not enough improvement and mention difficulties in performing exercises.

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“…The dropout rate in this observational study of (32 %) is high but comparable with other studies in which the drop-out rates vary from 11 % to 50 % [14, 15, 23]. …”

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 83%

Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study

et al. 2015

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“…Median follow-up was 18 (range: 6 to 30) months with more than 12 months in six trials [18]–[20], [22], [27] and 12 months or less in the other five. The number of participants ranged from 50 to 12,894 with less than 200 (range: 50 to 197) in five trials [19], [22]–[24], [26] and more than 200 (range: 230 to 12894) in the other six. Mean age reported in ten trials ranged from 11.2 (SD2.9) to 67.1 (SD11.0) years.…”

Section: Resultsmentioning

confidence: 99%

“…Mean age reported in ten trials ranged from 11.2 (SD2.9) to 67.1 (SD11.0) years. In ten trials, 35% of the population were male and one trial included women only [24].…”

Section: Resultsmentioning

confidence: 99%

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Effects of Physician-Nurse Substitution on Clinical Parameters: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundPhysicians’ shortage in many countries and demands of high-quality and affordable care make physician-nurse substitution an appealing workforce strategy. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the impact of physician-nurse substitution in primary care on clinical parameters.MethodsWe systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected peer-reviewed RCTs comparing physician-led care with nurse-led care on changes in clinical parameters. Study selection and data extraction were performed in duplicate by independent reviewers. We assessed the individual study risk of bias; calculated the study-specific and pooled relative risks (RR) or weighted mean differences (WMD); and performed fixed-effects meta-analyses.Results11 RCTs (N = 30,247) were included; most were from Europe, generally small with higher risk of bias. In all studies, nurses provided care for complex conditions including HIV, hypertension, heart failure, cerebrovascular diseases, diabetes, asthma, Parkinson’s disease and incontinence. Meta-analyses showed greater reductions in systolic blood pressure (SBP) in favour of nurse-led care (WMD −4.27 mmHg, 95% CI −6.31 to −2.23) but no statistically significant differences between groups in the reduction of diastolic blood pressure (DBP) (WMD −1.48 mmHg, 95%CI −3.05 to −0.09), total cholesterol (TC) (WMD -0.08 mmol/l, 95%CI -0.22 to 0.07) or glycosylated haemoglobin (WMD 0.12%HbAc1, 95%CI -0.13 to 0.37). Of other 32 clinical parameters identified, less than a fifth favoured nurse-led care while 25 showed no significant differences between groups.Limitationsdisease-specific interventions from a small selection of healthcare systems, insufficient quantity and quality of studies, many different parameters.Conclusionstrained nurses appeared to be better than physicians at lowering SBP but similar at lowering DBP, TC or HbA1c. There is insufficient evidence that nurse-led care leads to better outcomes of other clinical parameters than physician-led care.

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Nurses as substitutes for doctors in primary care

Laurant

Biezen²,

Wijers³

et al. 2018

Cochrane Database of Systematic Reviews

384

355

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Background Current and expected problems such as ageing, increased prevalence of chronic conditions and multi‐morbidity, increased emphasis on healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of primary care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing. Substitution of nurses for doctors is one strategy used to improve access, efficiency, and quality of care. This is the first update of the Cochrane review published in 2005. Objectives Our aim was to investigate the impact of nurses working as substitutes for primary care doctors on: • patient outcomes; • processes of care; and • utilisation, including volume and cost. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), part of the Cochrane Library ( ), as well as MEDLINE, Ovid, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and EbscoHost (searched 20.01.2015). We searched for grey literature in the Grey Literature Report and OpenGrey (21.02.2017), and we searched the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov trial registries (21.02.2017). We did a cited reference search for relevant studies (searched 27.01 2015) and checked reference lists of all included studies. We reran slightly revised strategies, limited to publication years between 2015 and 2017, for CENTRAL, MEDLINE, and CINAHL, in March 2017, and we have added one trial to ‘Studies awaiting classification’. Selection criteria Randomised trials evaluating the outcomes of nurses working as substitutes for doctors. The review is limited to primary healthcare services that provide first contact and ongoing care for patients with all types of health problems, excluding mental health problems. Studies which evaluated nurses supplementing the work of primary care doctors were excluded. Data collection and analysis Two review authors independently carried out data extraction and assessment of risk of bias of included studies. When feasible, we combined study results and determined an overall estimate of the effect. We evaluated other outcomes by completing a structured synthesis. Main results For this review, we identified 18 randomised trials evaluating the impact of nurses working as substitutes for doctors. One study was conducted in a middle‐income country, and all other studies in high‐income countries. The nursing level was often unclear or varied between and even within studies. The studies looked at nurses involved in first contact care (including urgent care), ongoing care for physical complaints, and foll...

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Effects of Introducing a Specialized Nurse in the Care of Community-Dwelling Women Suffering From Urinary Incontinence

Abstract: ISRCTN15553880.

Cited by 20 publications

References 52 publications

Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study

Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study

Effects of Physician-Nurse Substitution on Clinical Parameters: A Systematic Review and Meta-Analysis

Nurses as substitutes for doctors in primary care

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