3.4.1 Non-medically-led services: A systematic review of qualitative and quantitative evidence (165)
Janet Petty, Nurse Consultant, Faculty of Health & Social Care, Liverpool John Moores University, Liverpool, United Kingdom Co authors: Akhtar Wallymahmed jspetty@btinternet.com
Abstract:
Background:
Nursing and therapy-led services in the United Kingdom have increased substantially in recent years with the introduction of extended roles and advanced practice initiatives. Policy documents, including Liberating the Talents (DoH 2002) advocate the development of such services. Systematic reviews of non-medically-led services have in general, shown positive findings with regard to service user impact. However, service costs were generally higher and longer-term clinical outcomes were often unclear. This systematic review will inform the development of new services, assist sustainability and facilitate evidence-based practice.
Aims:
- To explore whether non-medically-led services are effective in terms of clinical outcomes
- To establish service user perspectives of non-medically-led services
- To determine the cost effectiveness of non-medically-led services
Methods:
A focus group reached consensus on inclusion criteria and types of interventions, along with the compilation of a substantial list of relevant search terms. Searches of the major databases including Medline, CINHAL and the British Nursing Index began in 2005. Potential studies that were initially identified using basic criteria of non-medically-led research and/or service evaluation totalled 5608. Abstracts were screened, and 520 selected for a full read through. The author and members of the focus group carried out further review of 150 studies using specifically designed data extraction forms. The final number of studies included in the systematic review is, 32 quantitative, 10 qualitative and 5 mixed methodology.
Analysis:
The chosen analytical approach for the qualitative studies uses a framework for meta-study described by Paterson et. al. (2001). Data from quantitative studies will be pooled, where appropriate, and analysed using a meta-analysis approach in line with methods described by the Cochrane Collaboration (Alderson et. al. 2004). The analysis phase is currently ongoing; the systematic review will be completed by the end of the year.
Recommended reading list:
- Department of Health (2002) Liberating the Talents: Helping Primary Care Trusts and Nurses to Deliver the NHS Plan. London
- Paterson, B.L., Thorne, S, E., Canam, C,. Jillings. (2001) Meta-Study of Qualitative Health Research: A Practical Guide to Meta-Analysis and Meta-Synthesis. Sage. Thousand Oaks
- Anderson, P., Green, S., Higgins, J.P.T. eds. Cochrane Reviewers Handbook 4.2.2 (updated March 2004). In the Cochrane Library, Issue 1, 2004. Chichester, UK. John Wiley & Son, Ltd
Source of Funding: N/A
Level of funding: N/A
Biography:
I have been in my current post for seven years and was one of the first nurse consultants in the country. I am employed by Western Cheshire Primary Care Trust and am a nurse member of the Professional Executive Committee. My interests include the development of nurse-led services and integrated stroke services. I am currently studying for a doctorate in nursing studies with Liverpool John Moores University. I live in Warrington and have a son.