| Medication and related therapy |
| Study | Outcome |
| Ansari 2003 | β‐blocker use was higher in the nurse facilitator group with two‐thirds of patients either initiated or up‐titrated on β‐blockers versus fewer than one‐third of patients in the other two study arms (control provider education and provider/patient notification). |
| Chenella 1983 | Little or no difference in amount of anticoagulant drugs prescribed by pharmacists compared to a physician. |
| Cohen 2011 | More patients in the pharmacist prescribing arm were prescribed diuretics and sulphonylureas compared to usual care. Overall there was an increase in the number of medications prescribed by pharmacists for hypertension, diabetes, and cholesterol from baseline to six months, but little or no change in the usual care arm. |
| Denver 2003 | In nurse‐led clinic for hypertension management in diabetics at six months there were increased changes in the proportions of patients receiving new prescriptions for calcium channel blockers and thiazide diuretics as intensification therapy. The median number of drugs per patient increased in the intervention group compared to conventional primary care. |
| Einhorn 1978 | In a family medicine clinic in Bogota, nurses were less likely than physicians to provide intrauterine devices, prescribe oral contraceptives, and sterilisation on the patient's first visit. Nurses were more likely than physicians to provide temporary prescriptions and defer intrauterine devices and contraceptive measures if the patient on their first visit was not menstruating or believed to be pregnant. |
| Heisler 2012 | Observational cohort results taken six months following the quarter start date showed intervention patients had more blood pressure medication changes. |
| Hirsch 2014 | Pharmacists identified at least one hypertension drug therapy problem in 33/73 (45.2%) patients at baseline requiring additional therapy in 14/33 (42.4%) and dosage increases in 11/33 (33.3%). |
| Houweling 2009 | The nurse specialist in diabetes prescribed significantly more antihypertensive agents and the internist (doctor control) prescribed more cholesterol‐lowering agents. |
| Hunt 2008 | The mean number of antihypertensive medications per patient and use of generic antihypertensive agents was higher in the intervention group. |
| Logan 1979 | Patients in the nurse‐managed group were more likely to be put on antihypertensive medications, prescribed more than two pills per day, and to be on more than one antihypertensive medication. |
| MacMahon Tone 2009 | There were more intervention intensive group patients on three or more antihypertensive drugs (at the study beginning more patients in the standard care group were on three or more antihypertensive agents). At the end of the study more patients with dyslipidaemia in the intensive group were receiving statin therapy. More patients in the intervention group were on aspirin antiplatelet therapy at the end of the study. |
| McAlister 2014 | The median number of antihypertensive medications taken at six months was probably not different in the pharmacist‐ and nurse‐led groups. There was a difference favouring pharmacists in maximal dosing of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers at six months, but not the percentage of patients using these drugs. |
| Magid 2013 | In patients completing the six‐month visit, there were more intervention patients that had an antihypertensive medication added to their regimen and a dose increased for existing medication, than usual care patients. There was an increase in the usage of specific antihypertensive drugs. |
| Margolis 2013 | There were increases in the mean number of antihypertensive medication classes at 6, 12, and 18 months in the intervention group compared to baseline and compared to usual care. |
| Moher 2001 | There was minimal change in prescribing antihypertensive drugs in the three groups. All groups increased prescribing of lipid‐lowering drugs but there was little or no difference between groups. There was an increase of 10% more patients’ prescribed antiplatelet treatment in the nurse recall group versus the audit group and 8% more in the nurse recall group versus the general practitioner recall group. |
| Pagaiya 2005 | In examining the effects of training and guidelines on prescribing by nurses, the mean change in antibiotic prescribing for all patients showed little or no difference. The mean change for antibiotic prescribing for respiratory infections in children (0 to 5 years) fell. No change was detected in prescribing antibiotics for diarrhoea. There was a mean fall in diazepam prescribing in the intervention group. |
| Rudd 2004 | In the nurse management patient group at six months there was an increased number and variety of antihypertensive medications and an increased number of medication changes than in the usual care group. |
| Taveira 2010 | The intervention arm group (VA‐MEDIC) had greater dose titrations of antihypertensive medications, insulin, statins, and niacin compared to the usual care arm. |
| Taveira 2011 | Intervention arm participants (VA‐MEDIC‐D) had more dose increases or initiation of any antihypertensive agents and more dose increases or initiation of antihyperglycaemic agents. There was little or no difference in the initiation or dose titration of any antihyperlipidaemic agent or antidepressants. |
| Thompson 1984 | The average number of drugs prescribed per patient was lower in the pharmacist group compared to the physician group. The number of drugs was reduced by an average of 2.2 drugs per patient from the pre‐study to the study year. The practice of clinical pharmacists prescribing drug therapy under physician supervision has the potential to save the healthcare system USD 70,000 per 100 skilled nursing facility beds. |
| Tsuyuki 2015 | In the pharmacist prescribing arm proportionally more new antihypertensive agents were initiated, more dose changes occurred, more antihypertensives were discontinued, and more patients were prescribed low‐dose aspirin and a statin than in the usual care group. |
| Vivian 2002 | There was little or no difference in the type of antihypertensives prescribed to intervention and control patients during the study. |
| Wallymahmed 2011 | Compared with baseline there were more patients in both groups taking antihypertensive medications but this difference was probably only important in the nurse‐led intervention group. |
| |
| Healthcare visits, health resources, and associated costs |
| Ansari 2003 | There was no difference in hospitalisations and emergency room visits between the three groups of control (provider education), nurse facilitator, and provider/patient notification. |
| Aubert 1998 | Hospital admissions were rare and did not differ between the intervention and usual care groups. ED visits did not differ between groups or from baseline. No hospital or ED visits were related to diabetes. The average number of outpatient visits during the study was similar. The nurse managed a case load of 71 patients, but it was estimated that a 300 patient case load could be managed. |
| Barr Taylor 2003 | There was no change in health utilisation (physician visits, ED visits, days of hospitalisation) for the year before and after the intervention and between groups. |
| Choe 2005 | In reporting process measures for the clinical pharmacist’s case management of patients there was a difference between pharmacist intervention and control in the frequency of low‐density lipoprotein measurements, retinal examinations, and monofilament foot examinations but not glycated haemoglobin measurement or urine albumin screen. |
| Cohen 2011 | Over six months there were a higher number of primary care visits in the usual care arm; an average 1.65 visits per patient versus 1.56 in the intervention arm. It was suggested the difference in the higher number of primary care visits may offset the intervention cost. |
| DeBusk 1994 | The nursing time spent in the year after myocardial infarction was nine hours per patient; a per patient cost of USD 500 which included the nurse salary, office costs, and other associated costs. This compared with cardiac rehabilitation programmes in the San Francisco Bay area costing USD 1800 to USD 2700 to participate for three months. |
| Ellis 2000 | In investigating the impact of clinical pharmacist interventions in patients with dyslipidaemia there was little or no difference in physician or nurse visits between control and the intervention patients at 12 months. At 12 months the intervention group had more pharmacist visits than the control group. There were little or no difference in costs for hospitalisations, clinic visits, laboratory costs, drug costs, and costs of lipid therapy between groups. The intervention group had a USD 370 greater difference per patient in total costs which was probably not important and approximately 5% of total costs. |
| Fairall 2008 | In the cohort of patients not yet receiving antiretroviral therapy there was little or no difference in clinic visits with a nurse but clinic visits with a doctor were probably higher in the intervention group. In the cohort of patients who had already received at least six months of antiretroviral therapy clinic visits with a nurse probably higher in the intervention group. Economic data from the study is the subject of further analysis by Barton 2013 (see Studies awaiting classification). |
| Finley 2003 | Although the collaborative care model experienced a decrease in the total number of primary care visits, the between‐group difference was probably not important. ED visits increased more in the usual care group but this was probably not important and neither was the difference in utilisation of psychiatric services. The institutional cost of drugs, the cost of antidepressants and the cost of psychotropic drugs overall was higher in the intervention group, but this was not important. |
| Fischer 2012 | Hospital admissions (while trending to fewer admissions) in the nurse intervention group showed little or no difference to the control group. Nurse case management was not associated with a significant difference in the number of outpatient or ED visits. There was a decrease in total costs in the nurse telephone intervention group comparing the period before and after randomisation. In contrast, there was an increase for the same comparison in the control group. Similar results were seen with hospitalisation and ED costs which were lower in the intervention group. There was probably not an intervention effect on outpatient costs. The difference in average per patient cost between the intervention group (USD 6600) and control group (USD 9033) of USD 2433 was important. The control group had higher baseline hospitalisation rates and total costs cautioning interpretation of the result. |
| Heisler 2012 | Little or no difference in health services utilisation (hospitalisations, primary care visits, ED visits) between intervention and control patients during the 14‐month study of blood pressure control through a clinical pharmacist outreach programme in diabetic patients. |
| Hirsch 2014 | The pharmacist collaborative group (PharmD‐PCP MTM) had fewer primary care physician visits during the intervention period than did the usual care group. The mean total combined visits of primary care physician and pharmacist was not greater in the PharmD‐PCP MTM group than in usual care. |
| Houweling 2009 | There was a lower number of visits in the NSD group compared with standard care but not in the duration of visits. Significantly more patients were referred back to their GP by the NSD when meeting treatment goals. Personnel and laboratory costs were lower in the intervention group than the control group. The average per month increase in medication costs between the groups was probably not important apart from the cholesterol‐lowering medications. The average time saving per internist was 61.4 minutes (meaning the internist could supervise 11 patients with the NSD in the time he/she could treat one patient). |
| Houweling 2011 | The mean number of visits and duration of visits was higher in the practice nurse intervention group than the control group. |
| Hunt 2008 | The total number of clinic visits (physician plus pharmacist) was higher in the intervention arm compared to the control arm. The number of physician visits was lower in the intervention arm. |
| Ishani 2011 | Little or no difference in the hospitalisation rate between intervention and control groups. |
| Kuethe 2011 | In testing the non‐inferiority of asthma care in children with stable asthma provided by a hospital‐based specialised asthma nurse versus a GP or paediatrician, there was little or no differences between the groups for medication, school absence or parental work absence after two years. There was little or no difference in unplanned visits and no hospital admissions during the study. |
| Litaker 2003 | Medium number of outpatient visits were higher for the team based intervention patients. Average personnel costs for one year's treatment were significantly higher in the intervention group (USD 134.68 vs USD 93.70, P < 0.001). |
| Magid 2013 | There was little or no difference in the mean number of outpatient clinic visits, total number of ED visits, and hospitalisations between the two groups. The intervention group probably had a higher number of email and telephone encounters. |
| Margolis 2013 | Over 12 months in the telemonitoring intervention group all 228 patients used a mean of 11.4 ± 3.9 pharmacist visits lasting a mean of 34.2 minutes and 217 used telemonitoring services with a mean of 9.8 ± 2.5 months of use. It was estimated direct programme costs would total USD 1350 per patient. |
| Spitzer 1974 | A reported five per cent drop in gross practice revenue was explained by the absence of billing for services provided by the nurse practitioner. Billing for unsupervised practice was not permitted in Ontario at the time of the study. During the trial year the services rendered by the nurse practitioner were worth approximately USD 16,000 of which almost 50% was for unsupervised practice. |
| Taveira 2011 | There was little or no differences in primary carer visits, use of ED services for all cause visits, diabetes‐related ED visits or hospital admission rates. |
| Thompson 1984 | There was little or no difference in the average length of stay or hospitalisations although the latter trended lower in the pharmacist group. Differences favouring the pharmacist group were found in the rate of discharge to home or to a lower level of care. |
| Vivian 2002 | Little or no differences between intervention and control groups in appointments with the primary care provider during the 6 months of the study. |
