Is the task-shifting in self-management support effective? A systematic review and meta-analysis

Background Nurses play a key role in primary care, especially in long term care programs for patients with chronic diseases. The taskshifting from medical doctors to appropriately trained nurses could be a possible way to reduce doctors’ workload and direct cost of care, keeping quality, health outcomes and patient satisfaction constant. Systematic review and meta-analysis was carried out to assess the effectiveness of nurse-led selfmanagement interventions in community setting. Methods Most important biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led self-management interventions performed in community setting on patients with a diagnosis of chronic disease or multimorbidity. Primary outcomes of the studies were our outcomes of interest. Pooled mean difference (MD), along with 95% confidence interval (CI) was calculated, as appropriate. Results Globally, 29 RCTs were included involving 10,240 participants. Six studies reported as outcomes the levels of HbA1c, 10 the systolic (SBP) and diastolic blood pressure (DBP). The pooled MD showed a reduction in HbA1c and in SBP in the experimental groups. Meta-analyses of subgroups showed a statistically significant effect of the interventions for SBP among diabetic patients (MD -2.56, 95% CI -4.82—-0.31). A reduction of the DBP was found on the overall group (MD - 1.42, 95% CI -1.42—-0.49) and in the subgroup of patients with cardiovascular diseases (-2.09, 95% CI -4.11—-0.07). All-cause mortality was found significantly lower in two studies out of four. Quality of life in the experimental groups was significantly higher than in the control group only in one RCT out of three. Conclusions The results support the effectiveness of a nurse-led approach in the management of clinical outcomes in chronic patients. In particular, the nurse-led approach has positive effects on the DBP and SBP control and Hb1AC level in patients with cardiovascular diseases or diabetes. Key messages: Task-shifting from doctors to nurses in educational and selfmanagement programs in community settings can improve clinical outcomes in chronic patients. Further research to evaluate cost-effectiveness of taskshifting interventions in the management of chronic patients is strongly needed