Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care. This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs). Umbrella review. We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers. We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses. The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.

中文翻译：

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由专业护士或高级执业护士进行的会诊对复杂健康状况患者患者和组织结局的影响： 总括性综述


政策制定者和研究人员经常建议，护士可以通过担任高级角色和提供护理咨询，在满足复杂疾病患者不断变化的需求方面发挥关键作用。护理咨询因环境和国家而异，其活动范围从补充到替代传统的医生主导的咨询或常规护理。本研究旨在描述在任何情况下与患有复杂疾病的患者进行护理咨询对患者结局（生活质量、身体状况、社会心理健康、健康行为、药物依从性、死亡率、人体测量和生理结局以及患者满意度）和组织结局（健康资源使用和成本）的影响。伞式评论。我们遵循 Joanna Briggs Institute 方法进行伞式评价。我们检索了 PubMed、Embase、Cochrane 系统综述数据库和 CINAHL，以确定 2013 年 1 月至 2023 年 2 月期间以英语、荷兰语、法语、西班牙语或德语发表的相关文章。我们纳入了系统的文献综述，有或没有meta分析，其中包括在高收入国家进行的随机对照试验。如果综述与由专业护士或高级执业护士领导的咨询有关，则符合纳入标准。文章筛选、资料提取和质量评价由至少两名评价员独立进行。我们纳入了基于 473 项独特试验的 50 篇系统综述。对于所有患者结局，护理咨询达到的效果至少与医生主导的咨询或常规护理相当（即非劣效性）。 对于生活质量、健康行为、药物依从性、死亡率和患者满意度，超过一半的荟萃分析发现，有利于护理咨询（即优越性）具有统计学意义的影响。必须谨慎解释成本结果，因为提取的成本相关数据非常少且异质，并且成本分析的方法质量值得怀疑。叙述性综合证实了荟萃分析的总体结论。护理咨询对不同医疗保健环境中患有复杂健康状况的患者的影响似乎至少与医生主导的咨询或常规护理相似。护理咨询在生活质量、健康行为、死亡率、患者满意度和药物依从性方面似乎比医生主导的咨询或常规护理更有效。有必要对原始数据进行进一步分析，以确定护理咨询最有效的患者群体和环境。中等研究质量、系统综述之间和系统综述内部的多样性以及报告质量阻碍了结果的强度。