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Practice nurse (PN)-led patient consultations and PN-led dosage adjustments of permanent medication are uncommon and not well studied in general practice (GP) in Germany. We investigated the perspectives of patients with common chronic diseases in Germany, diabetes mellitus (DM) type 2 and/or arterial hypertension (AT), on PN-led patient consultations and dosage adjustments of permanent medications in GP. In this exploratory qualitative study, online focus groups were conducted using a semi-structured interview guide. Patients were recruited from collaborating GPs according to a predefined sampling plan. Patients were eligible for this study if they had DM or AT treated by their GP, were on at least one permanent medication and were aged 18 years or older. Focus group transcripts were analyzed using thematic analyses. Analyses of two focus groups, involving a total of 17 patients, revealed four main themes: (1) openness to the PN-led care and perceived benefits, eg because of patients' confidence in PNs' skills, or patients' impression that PN-led care would better meet their needs and increase their compliance. Some patients had (2) reservations and perceived risks, especially for PN-led medication changes eg feeling that medication adjustments were a GP's issue. Patients identified (3) reasons for encounters where they were likely to accept PN-led consultation and medication advice, eg management of DM, AT and thyroid disease. Patients also saw several important general requirements for the implementation of PN-led care in German general practice (4). There is a potential for openness towards PN-led consultation and PN-led medication adjustment for permanent medication in patients with DM or AT. This study is the first qualitative study to investigate PN-led consultations and medication advice in German general practice. If the implementation of PN-led care is planned, our findings add the patients' perspectives of acceptable reasons for encounter for PN-led care and their general requirements.

Aim Nurse‐led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self‐care abilities. This study compared patients' improvements of self‐care abilities and frequency of readmission rate between nurse‐led care and regular nursing care within the acute hospital setting. Design A quasi‐experimental design within a real‐world setting was used for this work. Methods We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse‐led care). After propensity score matching, the study cohort consisted of 612 patients. Results From admission to discharge, nurse‐led care patients showed superior improvements of total self‐care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse‐led care were furthermore less frequently readmitted to hospital compared with the control group patients. Patient or public contribution No patient or public contribution.

Aim Bilevel positive airway pressure (BiPAP) management is a cornerstone in treating acute hypercapnic respiratory failure, with varying outcomes depending on the care model. This retrospective cohort study aims to compare the effectiveness of nurse‐led versus physician‐led BiPAP management in this context. Design Retrospective cohort study. Methods We analysed medical records of 189 patients with acute hypercapnic respiratory failure treated with BiPAP between January 2020 and December 2022. Patients were divided into nurse‐led (n = 101) and physician‐led (n = 88) groups based on their BiPAP management leadership. Outcomes measured included arterial blood gas (ABG) parameter improvements, intubation rates, length of hospital stay and 30‐day readmission rates. Statistical analysis involved chi‐squared tests, t‐tests, Mann–Whitney U tests and multivariable regression to adjust for confounders. Results Both groups demonstrated significant improvements in ABG parameters, with no significant differences between groups. The nurse‐led group exhibited a lower intubation rate (9.9% vs. 21.6%, p = 0.026) and higher patient satisfaction scores (median 8 vs. 6, p < 0.001). Mortality rates, complication rates and 30‐day readmission rates were similar between the groups. Multivariable logistic regression confirmed the nurse‐led group had a lower likelihood of intubation (AOR: 0.401, p = 0.032) and higher patient satisfaction (AOR: 7.770, p < 0.001). Patient or Public Contribution Our findings indicate that nurse‐led and physician‐led BiPAP management strategies for acute hypercapnic respiratory failure are equally effective in terms of ABG improvement, intubation rates, hospital stay length, and readmission rates. This suggests that with adequate training and supervision, nurse‐led BiPAP management can be as effective as physician‐led management, offering a viable alternative in healthcare settings where physician resources are limited.

Background Guideline non‐adherence and variations in therapeutic and diagnostic trajectories result in suboptimal atrial fibrillation (AF) treatments. Large academic and referral hospitals demonstrated positive effects of dedicated outpatient AF clinics. Although similar results have not been indicated in (small) non‐academic hospitals yet, ample opportunities are present when collaboration is initiated on a regional level. Therefore, this study assesses the effectiveness of outpatient AF clinics in a collaborative region in the Netherlands. Methods For this study baseline and 6 months follow‐up data of a prospective cohort including newly or recently diagnosed AF‐patients of 4 hospitals involved in the Netherlands Heart Network are used. From January’15 to March’16 patient relevant outcome measures (ie EHRA score, stroke, major bleedings, hospitalizations, serious adverse effects of medication, and mortality) are gathered. Descriptive and regression analyses are performed to assess the effectiveness of outpatient AF clinics. Results In the analyses 448 AF‐patients were included. After 6 months, significant improvements regarding EHRA score (P < 0.01), hypertension (P < 0.01), and type of AF (P < 0.01) were indicated. Results of the patient relevant outcomes showed that AF‐patients were hospitalized 23 times, no major bleedings and 2 strokes occurred. Furthermore, 0 AF‐patients reported serious adverse effects of medication and no AF‐patients deceased. Conclusions Collaboration between cardiologists in a regional setting permits further improvement of AF care. Therefore, such quality targets are not exclusively reserved to large academic or referral hospitals. Although promising, future research should put effort in measuring the effectiveness of the outpatient AF clinics also on the long run.

Aim The aim of this study was to investigate changes in patients' self‐management and health status five years after nurse‐led patient education. Design A longitudinal study. Methods We collected self‐reported data on physical function, pain, tiredness, disease activity, psychological status, patient activation and self‐efficacy from a sample of Norwegian‐speaking adults with inflammatory arthritis that had participated in a randomised controlled study investigating the effects of nurse‐led patient education. Changes and associations in patients' health status and self‐management were analysed with paired sample t tests and multivariable linear regression analyses, respectively. Results Except from a small deterioration in patients' physical function, there were no changes in patients' health status 5 years after the nurse‐led patient education. Patients' self‐management skills were improved after 5 years. Self‐efficacy was positively associated with female gender, patient activation, less tiredness and less psychological distress.

Purpose To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews. Methods MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized. Results Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors’ physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services. Conclusions Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups. Implications for Cancer Survivors Rather than aiming for an optimal “one-size fits all” model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.

Objective To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study.Design Systematic review and meta-analysis.Data sources Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database.Study selection Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.Data extraction Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.Data synthesis Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference −8.2 mm Hg, 95% confidence interval −11.5 to −4.9), nurse prescribing showed greater reductions in blood pressure (systolic −8.9 mm Hg, −12.5 to −5.3 and diastolic −4.0 mm Hg, −5.3 to −2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic −4.8 mm Hg, 95% confidence interval −7.0 to −2.7 and diastolic −3.5 mm Hg, −4.5 to −2.5).Conclusions Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

Atrial fibrillation (AF) is the most common arrhythmia worldwide and the majority of AF patients are treated in primary care. In order to minimize hospitalizations and visits to emergency departments, nurse-led care was introduced in secondary care and primary health care (PHC). However, even though nurse-led care was initiated in PHC almost a decade ago, and ESC guidelines recommended patient-centered integrated care including PHC for patients, there seems to be a lack of scientific evidence regarding the effects. To review the scientific literature regarding the effects of nurse-led AF clinics in PHC. A systematic review of scientific literature in Medline/Cinahl. Two reviewers independently assessed the retrieved articles. Only one study was found that investigated the effectiveness of nurse-led structured AF management in PHC. The results from the study indicated positive effects; 45% reduction in all-cause mortality compared to usual care and significantly lower number of all-cause hospitalizations with nurse-led care. Several studies were found analyzing the effects of nurse-led AF-care in secondary care facilities, but only one in PHC setting. The results mainly showed that nurse-led care in AF-clinics in secondary care reduces mortality, hospitalizations and visits in emergency departments. Even though only one study focused on PHC, the review indicated positive effects of nurse-led care for AF patients. However, the results are only based on studies performed in inpatient care. Hence, no firm conclusion can be drawn about nurse-led AF-clinics in PHC, and more research is clearly needed in this area.

To systematically evaluate the effect of nurse‐led and physician‐led multidisciplinary team (MDT) palliative care models on quality of life, negative emotions, and pain for cancer patients. A comprehensive literature search of randomized controlled trials (RCTs) published in nine databases was conducted. Data analysis was performed using RevMan5.3. The findings were summarized using a random effects model of mean differences with 95% confidence intervals. The search strategy identified 15 articles involving 1850 cancer patients. MDT hospice care improved quality of life among cancer patients (SMD = 1.77, 95% CI [1.08, 2.46], Z = 5.02, p < .001), with nurse‐led care (SMD = 3.04, 95% CI [2.29, 3.79], Z = 7.95, p < .001) providing better effects than physician‐led care (SMD = 0.5, 95% CI [0.33, 0.67], Z = 5.76, p < .001). Furthermore, MDT hospice care significantly alleviated depression (SMD = –1.31, 95% CI [−1.49, −1.12], Z = 14.18, p < .001) and anxiety (SMD = –1.11, 95%CI [−1.29, −0.92], Z = 11.69, p < .001) and reduced patients' pain (SMD = –0.92, 95% CI [−1.13, −0.7], Z = 8.37, p < .001). Nurse‐led care provided better effects for relieving anxiety and depression, while physician‐led care provided better effects for relieving pain. The findings of the meta‐analysis indicate that MDT palliative care can improve the quality of life for cancer patients and alleviate their depression, anxiety and their pain. Nurse‐led care was superior in terms of quality of life, depression, and anxiety indicators, while physician‐led care had a more significant effect on pain relief. Flow diagram of study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses;RCT,randomized controlled trial.