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The effectiveness and cost‐effectiveness of clinical nurse specialists in outpatient roles: a systematic review
Author(s) -
Kilpatrick Kelley,
Kaasalainen Sharon,
Donald Faith,
Reid Kim,
Carter Nancy,
BryantLukosius Denise,
MartinMisener Ruth,
Harbman Patricia,
Marshall Deborah Anne,
CharbonneauSmith Renee,
DiCenso Alba
Publication year - 2014
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12219
Subject(s) - medicine , cinahl , medline , health care , randomized controlled trial , family medicine , systematic review , cost effectiveness , grading (engineering) , outpatient clinic , quality (philosophy) , economic evaluation , nursing , psychological intervention , risk analysis (engineering) , philosophy , civil engineering , engineering , epistemology , pathology , political science , law , economics , economic growth
Rationale, aims and objectives Increasing numbers of clinical nurse specialists ( CNSs ) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials ( RCTs ) evaluating the cost‐effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles. Methods We searched CINAHL , MEDLINE , EMBASE and seven other electronic databases, 1980 to J uly 2012 and hand‐searched bibliographies and key journals. RCTs that evaluated formally trained CNSs and health system outcomes were included. Study quality was assessed using the C ochrane risk of bias tool and the Q uality of H ealth E conomic S tudies instrument. We used the G rading of R ecommendations A ssessment, D evelopment and E valuation to assess quality of evidence for individual outcomes. Results Eleven RCTs , four evaluating alternative provider ( n = 683 participants) and seven evaluating complementary provider roles ( n = 1464 participants), were identified. Results of the alternative provider RCTs (low‐to‐moderate quality evidence) were fairly consistent across study populations with similar patient outcomes to usual care, some evidence of reduced resource use and costs, and two economic analyses (one fair and one high quality) favouring CNS care. Results of the complementary provider RCTs (low‐to‐moderate quality evidence) were also fairly consistent across study populations with similar or improved patient outcomes and mostly similar health system outcomes when compared with usual care; however, the economic analyses were weak. Conclusions Low‐to‐moderate quality evidence supports the effectiveness and two fair‐to‐high quality economic analyses support the cost‐effectiveness of outpatient alternative provider CNSs . Low‐to‐moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs ; however, robust economic evaluations are needed to address cost‐effectiveness.