Specialist home‐based nursing services for children with acute and chronic illnesses
Abstract
Background
Specialist paediatric home‐based nursing services have been proposed as a cost‐effective means of reducing trauma resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay.
Objectives
To evaluate specialist home‐based nursing services for children with acute and chronic illnesses.
Search methods
Electronic searches were made of CENTRAL (Cochrane Central Register of Controlled Trials) 2005 (Issue 2); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); PsycINFO (1887 to August 2005); CINAHL (1982 to August 2005); Sociological Abstracts (1963 to August 2005). Optimally sensitive search strategies for randomised controlled trials (RCTs) were combined with medical subject headings and text words specific for ambulatory paediatrics, nursing outreach and 'hospital in the home', and no language restrictions were applied.
Selection criteria
RCTs of children aged 0‐18 with acute or chronic illnesses allocated to specialist home‐based nursing services compared with conventional medical care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs.
Data collection and analysis
Meta‐analysis was not appropriate because of the clinical diversity and lack of common outcomes measures
Main results
1655 titles yielded 5 RCTs with a total of 771 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported improvements in child and parental anxiety; one study reported no significant difference in readmissions; two studies reported significantly fewer bed days; increased satisfaction was reported ; home care was more costly for service providers, but less expensive for parents.
Authors' conclusions
While current research does not provide definitive support for specialist home‐based nursing services in reducing access to hospital services or length of stay, preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home‐based care. Further trials are required, measuring health, satisfaction, service utilisation and long‐term costs.
PICOs
Plain language summary
Specialist home‐based nursing services for children with acute and chronic illnesses
Specialist paediatric home‐based nursing services for children with acute and chronic illnesses can potentially reduce hospital admission and length of stay, enhance health care in the community and reduce stress for families at the time of their child's illness. This review examines five randomised controlled trials (RCTs) of children aged 0‐18 with acute and or chronic illnesses allocated to specialist home‐based nursing services compared with conventional medical care. Outcomes studied include utilisation of health care services, physical and mental health, satisfaction, adverse health outcomes and costs. Synthesis of the results of these RCTs was not appropriate because of heterogeneity in the types of service provided, the patients and outcome measures. Examination of the results of individual RCTs shows improved satisfaction with home‐based care with no adverse impact on physical health outcomes for children. There is no evidence that specialist home‐based nursing services reduce access to hospital services or length of stay. Further trials are required, measuring health, satisfaction, service utilisation and long‐term cost evaluation.
