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Nurse-led versus doctor-led care for bronchiectasis
Kathryn Lawton1, Karen Royals, Kristin V Carson-Chahhoud
1Respiratory Medicine Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia.
The Cochrane Database of Systematic Reviews
|June 22, 2018
Summary
Nurse-led care for stable bronchiectasis showed no significant difference in exacerbations compared to doctor-led care. However, nurse-led care resulted in more hospital admissions and higher initial costs, though costs became equitable over time.
Area of Science:
- Respiratory Medicine
- Nursing Practice
- Health Services Research
Background:
- Specialist nursing roles are increasingly utilized to manage stable disease populations, offering an alternative to traditional doctor-led care amidst rising healthcare costs.
- Nurse-led care models are gaining traction as a strategy to meet patient and health service needs.
- This review focuses on the safety, effectiveness, and health outcomes of nurses practicing autonomously with advanced skills in managing bronchiectasis.
Purpose of the Study:
- To compare the effectiveness of nurse-led care versus doctor-led care in managing stable bronchiectasis.
Main Methods:
- A systematic review was conducted searching multiple databases and grey literature up to March 2018.
- Randomized controlled trials (RCTs) were the eligible study design.
- Data extraction and analysis focused on primary outcomes including antibiotic-treated exacerbations, hospital admissions, and emergency department attendances.
Main Results:
- One RCT involving 80 participants with bronchiectasis was included. No significant difference was found in antibiotic-treated exacerbations between nurse-led and doctor-led care (rate ratio 1.09, 95% CI 0.91 to 1.30).
- Nurse-led care was associated with more hospital admissions (rate ratio 1.52, 95% CI 1.04 to 2.23).
- Higher healthcare resource utilization and treatment costs were observed in the initial phase of nurse-led care, though costs became comparable by the second year. No significant differences in quality of life, exercise capacity, mortality, or lung function were detected.
Conclusions:
- Based on a single study, the effectiveness of nurse-led care compared to doctor-led care for stable bronchiectasis remains unclear.
- Limited evidence prevents definitive conclusions on clinical outcomes, highlighting the need for further research.
- Future research should investigate the cost-effectiveness and efficacy of nurse-led bronchiectasis management in various clinical settings.
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