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Table 2 Revision of professional roles

From: Organizational interventions to implement improvements in patient care: a structured review of reviews

Author, number of studies Quality score Focus Main results
Beney 2000
N = 16
7 Enlargement of the role of the public pharmacist Changed use of healthcare services (PSI 6/6 = 100%). Improved patient outcomes (PSI 10/13 = 77%). No change in: quality of life.
Bower 2000
N = 38
9 Mental health workers in primary care: replacement of/consultation to primary care providers *Replacement: lowered consultation rates (PSI 2/8 = 25%), short term reduction on psychotropic prescribing (PSI 4/11= 36%), long term changes psychotropic prescribing (PSI 3/6 = 50%), reduced mental health referrals (PSI 3/6 = 50%). *Consultation: more appropriate short term prescribing (PSI 3/6 = 50%). No change in: consultation rates, referral patterns.
Brown 1995
N = 13
4 Nurse practitioners in primary care Improved laboratory testing (AES 0.20), resolution of pathological conditions (AES 0.28), patient satisfaction (AES 0.30). No change in: quality of care, prescribing, functional status, consultation rates, use of emergency service.
Dijkstra 2004
N = 13
7 Revision of professional roles for guideline implementation in hospitals Improved professional performance (AOR 9.78, S).
Horrocks 2002
N = 11
6 Nurse practitioners in primary care Improved patient satisfaction (SMD 0.27), longer consultations (WMD 3.67 minutes), more investigations (OR 1.22). No change in: health status.
Loveman 2003
N = 6
8 Specialist nurses in diabetes mellitus No change in: HbA1c, emergency admissions, quality of life.
Stone 2002
N = 20
6 Organizational change (mainly involvement of non-physician staff and clinics devoted to prevention) to improve adult immunization and cancer screening Improved preventive activities
(AOR range 2.74 – 17.6).
Smith 2001
N = 4
7 Outreach nursing for chronic obstructive pulmonary disease Increased hospital service utilization
(PSI 2/2 = 100%).
No change in: mortality, lung function, health related quality of life.
Thompson 2003
N = 7
8 Dietary advice by dietitians compared to self-management materials. No change in: patient outcomes.