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A systematic review of the effectiveness of clinical nurse specialist interventions in
patients with chronic obstructive pulmonary disease (COPD) Cover

A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease (COPD)

By: Hua Yin,  Ling Yang and  Qiao Ye  
Open Access
|Aug 2018

Figures & Tables

Figure 1

Article search diagram.
Article search diagram.

Figure 2

Summary of risk of bias for included trials.
Summary of risk of bias for included trials.

Alternative keywords and search strategy_

PopulationInterventionsOutcome
1. Chronic respiratory disease5. Nurse specialist15. Safe*
2. Discharged6. Clinical nurse specialist16. Effective
3. Chronic obstructive pulmonary disease7. Advance practice nurse17. Effectiveness
4. COPD8. Special nurse-led18. Exercise tolerance
9. Specialist-led19. Pulmonary function
10. RNS-led20. Mortality
11. RNS21. Satisfaction
12. CNS-led22. The quality of life
13. Home-based23. Low cost
14. Outreach nursing24. Economic
25. Cost effectiveness
26. Combination of 1–4 using “OR”27. Combination of 5–14 using “OR”28. Combination of 15–25 using “OR”
The last step is to combine 26+27+28 using “AND”

Characteristics of included studies_

Author (date published)JournalSettingSampleIntervention groupControl groupOutcomesDuration of the studyNotes
Smith et al. (1999)Australian and New Zealand Journal of MedicineAdelaide, AustraliaPatients with principal diagnosis of COPD attending The Queen Elizabeth Hospital (N=96)Patients received home-based nursing interventions including condition monitor, education, and early identification of exacerbations after leaving the hospitalPatients received usual care and education from outpatient clinics and GP services

  • Hospital admission

  • Length of stay

  • Emergency and outpatient department attendances

  • Mortality rate

  • FEV1

  • Health-related guality of life

  • HRQL for patient caregivers

12 monthsHealth-related guality of life was improved
Cotton et al. (2000)ThoraxGlasgow, UKPatients with diagnosis of exacerbation of COPD attending the Royal College of Physicians of London (N=81)The patients in the intervention group were sent home within 3 days after admitted. These patients were visited by a specialized nursePatients received the care of the medical unit and discharge with usual admission duration

  • Readmission

  • Additional hospital days

  • Mortality within 60 days

14 monthsPatients with acute exacerbations of COPD can be discharged home earlier than the current practice
Davies et al. (2000)BMJLiverpool, UKPatients with diagnosis of COPD based on standard criteria (N=150)Patients were visited morning and evening by nurses for three days after dischargePatients received inpatient admission as usual

  • Readmission rates at 2 weeks and 3 months

  • Changes in FEV1

  • Mortality

  • Health status of patients

  • Health-related guality of life

18 monthsNo difference was found in mortality and FEV1
Griffiths et al. (2000)The LancetWales, UKLocal hospital and local GP referring (N=200)The treatment group received a multidisciplinary treatment, including two sessions: a general education session and an individualized physical training sessionPatients continued with their usual outpatient or primary care followup for 1 year

  • Health service use

  • Walking tolerance

  • Health status including St. George’s Respiratory Questionnaire

12 monthsWalking ability and health status were improved
Skwarska et al, (2000)ThoraxEdinburgh, UKPatients with exacerbation of COPD admitted to the Royal Infirmary of Edinburgh (N=184)Patients in the supported discharged group were discharged home with an appropriate treatment package and visited at home by a specialist nurse at the following dayPatients received treatment by the hospital team and discharge as usual

  • Health status (FEV1, etc.)

  • Patients satisfaction

  • Quality of life (Chronic Respiratory Questionnaire)

  • Mean health service cost

  • Rate of readmission for 8 weeks

18 monthsNo difference in readmission and health status, satisfaction was good, and the average cost was much lower
Hernandez et al. (2003)European Respiratory JournalBarcelona, SpainPatients in the ER of two hospitals in the Barcelona area (N=222)Patients in the intervention group supported by a skilled specialist nurse called patients regularly and provide consultation service, All of these calls and service were free within eight weeks after discharge.Patients were evaluated by the attending physician. At discharge, the patient was usually supervised by the primary care physician

  • Mortality

  • Hospital readmissions

  • Rate of ER visit

  • Quality of life (St. George’s Respiratory Questionnaire)

  • Knowledge of the disease

  • Patients’ satisfaction

  • Health condition

  • Overall direct cost per patient

  • Days of inpatient hospitalization

12 monthsComprehensive home care is cost effective
Vrijhoef et al. (2007)Chronic IllnessAlkmaar, the NetherlandsPatients from the respiratory outpatient clinic of general and teaching hospital (N=187)Patients in the intervention group were transferred to respiratory nurses instead of respiratory physiciansPatients assigned to the usual care group received routine respiratory outpatient care provided by the respiratory care physician and follow-up consultations from their respiratory care physician at the outpatient clinic

  • Clinical parameters (caregivers’ registries)

  • Health status (COOP/WONCA chart, St George’s Respiratory Questionnaire)

  • Self-care behavior (including knowledge, Dutch instrument)

  • Patient satisfaction

  • Consultation with the main care providers

16 monthsRespiratory nurse reported more consultations, worsening in FV2008C, improvements in subjective knowledge, self-assessed rate for coping with COPD, and overall satisfaction
Efraimsson et al. (2008)Scandinavian Journal of Caring SciencesSwedenPatients with COPD from a Swedish primary care setting (N=52)Patients received an education that laid emphasis on self-care ability and supported them according to their specific needs and ability to deal with the diseaseThe control group received a conventional care, including a first visit to the nurse, spirometry, and a follow-up visit to a physician

  • Knowledge of COPD and smoking habits (questionnaire specially developed for this study)

  • Quality of life (St. George’s Respiratory Questionnaire)

10 monthsThe program can improve patients’ quality of life and have effect on smoking habits
Sridhar et al. (2008)ThoraxWest London, UKPatients with acute exacerbation of COPD admitted to a hospital in London (N=122)Patients received a care package incorporating initial pulmonary rehabilitation and self-management education and other support by a specialist nurseUsual treatment from their primary care physician, secondary care physician, and/or the respiratory nursing service as appropriate

  • Hospital readmission rate

  • Unscheduled primary care consultations

  • Quality of life (Chronic Respiratory Questionnaire)

24 monthsSelf-management of patients was improved
DOI: https://doi.org/10.2478/fon-2018-0019 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 147 - 156
Submitted on: Sep 3, 2017
Accepted on: Nov 25, 2017
Published on: Aug 14, 2018
Published by: Shanxi Medical Periodical Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2018 Hua Yin, Ling Yang, Qiao Ye, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.