Measuring performance of professional role substitution models of care against traditional medical care in healthcare—A systematic review

Abstract Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: − 145.02 €/patient; 95%CI: − 251.89 to − 38.14; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 22.18 €/patient; 95%CI: 0.40 to 43.96; n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 450 €/patient; 95%CI: − 80 to 970; n = 819). Conclusions This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.

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Faculty Opinions recommendation of Systematic review of safety checklists for use by medical care teams in acute hospital settings--limited evidence of effectiveness.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13484065.14861182 ◽

2012 ◽

Author(s):

Jeffrey Braithwaite ◽

Geetha Ranmuthugala

Keyword(s):

Systematic Review ◽

Medical Care ◽

Acute Hospital ◽

Limited Evidence

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Effectiveness, cost effectiveness, acceptability and implementation barriers/facilitators of chronic kidney disease management programs and models of care for Aboriginal and Torres Strait Islander Australians: a mixed methods systematic review protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201513040-00007 ◽

2015 ◽

Vol 13 (4) ◽

pp. 65-86

Author(s):

Rachel Reilly ◽

Katharine Evans ◽

Judith Gomersall ◽

Gillian Gorham ◽

Steven Warren ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Cost Effectiveness ◽

Kidney Disease ◽

Torres Strait Islander ◽

Models Of Care ◽

Systematic Review Protocol ◽

Implementation Barriers ◽

Review Protocol ◽

Torres Strait

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Effectiveness of medical compared to multidisciplinary models of care for adult persons with pre-dialysis chronic kidney disease: a systematic review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201008260-00001 ◽

2010 ◽

Vol 8 (26) ◽

pp. 1058-1087

Author(s):

Haakan Strand ◽

Deborah Parker

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Models Of Care

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Exploring Residential Models of Care for Treatment of Infectious Complications Among People Who Inject Drugs: a Systematic Review

International Journal of Mental Health and Addiction ◽

10.1007/s11469-019-00113-1 ◽

2019 ◽

Vol 18 (3) ◽

pp. 772-783

Author(s):

Kaitlin G. Saxton ◽

David Barrett ◽

Laurie Gould ◽

Rachel M. Sandieson ◽

Sharon Koivu ◽

...

Keyword(s):

Systematic Review ◽

People Who Inject Drugs ◽

Models Of Care ◽

Infectious Complications

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Bereavement care for ethnic minority communities: A systematic review of access to, models of, outcomes from, and satisfaction with, service provision

10.1101/2021.02.13.21251679 ◽

2021 ◽

Author(s):

Catriona Rachel Mayland ◽

Richard A. Powell ◽

Gemma Clarke ◽

Bassey Ebenso ◽

Matthew J Allsop

Keyword(s):

Systematic Review ◽

Ethnic Minority ◽

Service Provision ◽

Models Of Care ◽

Cochrane Library ◽

Minority Populations ◽

Minority Communities ◽

Ethnic Minority Populations ◽

Bereavement Care

AbstractObjectivesTo review and synthesize the existing evidence on bereavement care, within the United Kingdom (UK), for ethnic minority communities in terms of barriers and facilitators to access; models of care; outcomes from, and satisfaction with, service provision.DesignA systematic review adopting a framework synthesis approach was conducted. An electronic search of the literature was undertaken in MEDLINE, Embase, PsycINFO, Social Work Abstract and CINAHL via EBSCO, Global Health, Cochrane library, the Trip database and ProQuest between 2000 and 2020. Search terms included bereavement care, ethnic minority populations and the UK setting.ResultsFrom 3,185 initial records, following screening for eligibility, and full-text review of 164 articles, seven studies were identified. There was no research literature outlining the role of family, friends and existing networks; and a real absence of evidence about outcomes and levels of satisfaction for those from an ethnic minority background who receive bereavement care. From the limited literature, the overarching theme for barriers to bereavement care was ‘unfamiliarity and irregularities’. Four identified subthemes were ‘lack of awareness’; ‘variability in support’; ‘type and format of support’; and ‘culturally specific beliefs’. The overarching theme for facilitators for bereavement care was ‘accessibility’ with the two subthemes being ‘readily available information’ and ‘inclusive approaches’. Three studies reported on examples of different models of care provision.ConclusionsThis review reveals a stark lack of evidence about bereavement care for ethnic minority populations. In particular, understanding more about the role of family, friends and existing support systems, alongside outcomes and satisfaction will begin to develop the evidence base underpinning current provision. Direct user-representation through proactive engagement and co-design approaches may begin to determine the most appropriate models and format of bereavement care for ethnic minority communities to inform service design and delivery.

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Taking Care of Physicians children

PEDIATRICS ◽

10.1542/peds.30.4.666a ◽

1962 ◽

Vol 30 (4) ◽

pp. 666-667

Author(s):

MORRIS A. WESSEL

Keyword(s):

Medical Care ◽

Professional Role ◽

Medical Problem ◽

Professional Responsibilities ◽

Taking Care

The articles, "The Physicians Children as Patients" by John H. Kennell and Willard D. Boaz, and "Should not Physicians' Families be Allowed the Comfort of Paying for Medical Care?" by Benjamin M. Spock, in the July, 1962, issue of Pediatrics call attention to an important medical problem. Doctor-parents do indeed need help in establishing a definite, well-defined relationship with their pediatricians. The physician who accepts this professional role should describe clearly for the doctor family, as for any other family, his plans for carrying out his professional responsibilities and his desire to be of service to his patients.

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Factors influencing nurse spiritual care practices at the end of life: A systematic review

Palliative & Supportive Care ◽

10.1017/s1478951521001851 ◽

2021 ◽

pp. 1-19

Author(s):

Rita Mascio ◽

Megan Best ◽

Sandra Lynch ◽

Jane Phillips ◽

Kate Jones

Keyword(s):

Systematic Review ◽

Social Influence ◽

End Of Life ◽

Spiritual Care ◽

Professional Role ◽

Community Settings ◽

Related Factors ◽

Factors Influencing ◽

Competency Frameworks ◽

Care Practices

Abstract Objectives The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients. Methods A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses’ spiritual/existential care practices toward adult end-of-life patients. Results The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources. Significance of results A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

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Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676835 ◽

2019 ◽

Vol 119 (02) ◽

pp. 294-307 ◽

Cited By ~ 10

Author(s):

Ruth Pritchett ◽

Danai Bem ◽

Grace Turner ◽

G. Thomas ◽

Joanne Clarke ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Medical Care ◽

Stroke Prevention ◽

Assessment Tool ◽

Peer Group ◽

Oral Anticoagulants ◽

Controlled Trials ◽

Computerized Decision Support ◽

Appropriate Prescription

Objective Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention. Methods Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention. Results Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription. Conclusion Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

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