Abstract
BackgroundPrimary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primary care setting.MethodsA search of Medline, Embase, PsycInfo, and CINAHL databases was undertaken to locate controlled intervention trials published between 1992 and May 2014 that provided practice change interventions to primary care nurses and/or allied health professionals to increase preventive care. The effect of interventions aimed at increasing the provision of any of the five care elements for any of the four behavioural risks was examined. A narrative synthesis was utilised.ResultsFrom 8109 articles, seven trials met the inclusion criteria. All trials bar one, assessed multi-strategic practice change interventions (three to five strategies) focused on care by nurses (six trials) or mixed nursing/allied health clinicians. One trial examined care provision for all four risks, five trials examined care for smoking only, and one trial examined care for alcohol consumption only. For the six trials reporting significance testing (excludes one smoking care trial), significant effects favouring the intervention group were reported in at least one trial for smoking risk assessment (2/4 trials reported an effect for at least one analysis of an assessment outcome), brief advice (2/3), assistance (2/2), and arranging referral (2/3); alcohol risk assessment (1/2) and brief advice (1/2); inadequate nutrition risk assessment (1/1); and physical inactivity risk assessment and brief advice (1/1). When the number of analyses undertaken within trials focusing on smoking care was considered, the results were less promising (e.g. of the 15 analyses conducted on brief advice variables across three trials, four showed a positive effect).ConclusionsEvidence for the effect of practice change interventions on preventive care by primary care nurses or allied health providers is inconclusive given the small number of trials and inconsistency of results between and within trials.Systematic review registration numberNoneElectronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0409-3) contains supplementary material, which is available to authorized users.
Highlights
Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care
Given no systematic reviews have examined the effectiveness of practice change interventions in increasing primary care nurses and/or allied health professionals provision of recommended elements of preventive care for any of the four priority behavioural risks, a systematic review following PRISMA guidelines was undertaken that aimed to summarise such evidence
7735 articles were excluded as the following: two were not in English; 18 were not journal articles; 7189 were a study protocol, review, or editorial, or did not quantitatively describe the proportion of health professionals providing, or clients provided with preventive care for at least one of the four risks; 25 were based on data related to care for children; 102 were not in a primary care setting; 16 described care that was not provided by routine staff; 308 were not intervention trials or did not have a control/comparison group; 52 did not include nurses or allied health professionals as a Distribution of educational materials
Summary
Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care. Five preventive care elements are recommended to meet this guidance: asking all patients about the four behavioural risks (risk assessment); assessment of readiness to change and dependence (for smoking and alcohol); brief, nonjudgemental advice with patient educational materials and motivational interviewing; assistance by providing motivational counselling and pharmacotherapy if required (for nicotine or alcohol dependence); and arrangement of a referral to telephone support services, group lifestyle programs, or an individual provider (e.g. dietician), and a follow-up visit where applicable [17, 18]. These elements are commonly referred to as the 5A’s [1]
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