Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis.
Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis.
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DOI：
10.1136/bmj.c3995
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发表时间：
2010-08-23
期刊：
影响因子：
--
通讯作者：
Campbell JL
中科院分区：
文献类型：
--
作者：
Clark CE;Smith LF;Taylor RS;Campbell JL
目的回顾护士主导的高血压干预试验，以澄清证据基础，确定护士处方是否是一种重要的干预措施，并确定需要进一步研究的领域。设计系统综述和荟萃分析。数据来源：奥维德Medline、科克伦对照试验中心登记处、英国护理索引、Cinahl、Embase、疗效评价摘要数据库和NHS经济评价数据库。研究选择：成人高血压护理干预与常规护理的随机对照试验。数据提取收缩压和舒张压，达到目标血压的百分比，服用降压药的百分比。干预效果计算为相对风险或加权平均差异，并根据研究质量进行敏感性分析。数据综合与常规治疗相比，包括阶梯式治疗算法的干预措施显示收缩压降低幅度更大（加权平均差为-8.2 mmHg，95%置信区间为-11.5至-4.9），护士处方显示血压降低幅度更大（收缩压-8.9 mm Hg，-12.5至-5.3;舒张压-4.0 mm Hg，-5.3至-2.7），电话监测显示血压目标实现率较高（相对危险度1.24，95%可信区间1.08 ~ 1.43），社区监测显示血压下降幅度更大（加权平均差，收缩压-4.8 mmHg，95%置信区间-7.0至-2.7，舒张压-3.5 mmHg，-4.5至-2.5）。结论护士主导的高血压干预需要一个算法来构建护理。有证据表明，来自非英国医疗机构的护士处方者的结局有所改善。来自英国初级卫生保健的高质量证据不足以支持在这种医疗保健系统中广泛雇用护士管理高血压。
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.
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