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Nowadays, medical professionals recognize that EBP or evidence-based practice is a crucial component for offering top-quality care to make sure that the patient receives the best outcome. Findings collected from various studies that included the EBP approach have presented evidence of improved results in health, costs, and safety, as well as a decline in morbidity rates. This means that when clinicians possess information on how to find and evaluate useful evidence in their clinical practice, they are much more effective in providing high-quality care for their patients. Thus, an evaluation of studies conducted with evidence-based practice in mind is necessary for getting information on how the quality of health care can be improved, concerning particular health conditions.
Research Problem Relevance
The research reviewed was the 2013 nurse- versus physician-led care for the management of asthma, conducted by Kuethe, Vaessen-Verberne, Elbers, and Van Aalderen. The background for the study lay in the fact that asthma is one of the most widespread chronic illnesses people experience, both in childhood and adulthood, thus greatly impacting available healthcare resources. Therefore, adequate health care is required to properly deal with asthma and reduce cases of morbidity, as well as improve the quality of healthcare services provided by medical facilities. The study is relevant, as it aims to identify and review the effectiveness of asthma care provided to patients by their physicians, and to compare this care with care provided by nurses, nursing practitioners, and other nursing professionals who usually work autonomously from a physician (Kuethe, Vaessen-Verberne, Elbers, & Van Aalderen, 2013, p. 1).
The relevance of the nursing research problem addressed in the study is linked to the importance of intelligently using human resources in health care. For instance, since the outpatient management provided by a nurse could be implemented in a lower-cost care facility, efficient review and research were needed to provide evidence for the assumption that the health care provided by a nurse is not inferior in any way. Thus, the study is innovative, as there has not been any effective literature review conducted on the issue of nurse- versus physician-led care in patients who suffer from asthma. Furthermore, the study can become a basis for nurse research- versus physician-led healthcare, about other chronic and non-chronic diseases that pose a great challenge to the capabilities of modern health care, and influence mortality rates worldwide. These diseases may include type 2 diabetes mellitus, coronary artery disease, cancer, HIV/AIDS, and tuberculosis.
Levels of Evidence
The study included randomized controlled trials that involved both adult and juvenile participants who suffer from asthma, with no restriction placed on participants with co-morbidities. The research method included an extensive list of relevant studies on the topic, derived from the Cochrane Airways Group Specialized Register of trials. The selection of the studies was conducted by two independent review authors who were responsible for screening the studies and then assessing the selected studies for inclusion while resolving any disagreements in the course of a discussion (Kuethe et al., 2013, p. 6). Such a method of study selection may have proven to be efficient concerning this research; however, it is weak, in the sense that it limits the scope of the reviews to only two individuals. The demographic for the study included age and gender, which, in the case of studying nurse- versus physician-led care in asthma patients, is efficient. The study design included exclusion and inclusion criteria, sample size, randomization method, and follow-up procedures. Such a study design was effectively used, as it accounted for the lowest possible level of bias.
The levels of evidence presented in the reviewed literature are not uniform. For instance, in the outcome of the frequency of exacerbations, different definitions for exacerbations were found among the reviewed studies; thus, there was no possibility for meta-analysis. When it comes to the symptoms and the severity of the disease in question, only one study provided information on asthma severity. Furthermore, direct and indirect healthcare costs were only reported in one study, which is evidence of the lack of information on the cost to manage asthma in a healthcare setting. The quality of life was assessed using various questionnaires, and all studies reviewed in the article reported quality of life on various scales; however, there was no evidence about important differences in the quality of the participants’ lives. The risk of hospital readmissions was assessed based on the pooled risk differences (Kuethe et al., 2013, p. 4).
Presented and Critiqued Studies
The studies reviewed in the article were presented in “Characteristics of included studies” tables that included columns for method, participants, interventions, outcomes, notes, and risk of bias, giving, in brief, a summary of information needed for the review. The table included five studies by Kamps (2003), van Son (2004), Kuethe (2011), Pilotto (2004), and Nathan (2006). After a complete review of the selected studies, eighteen studies were excluded, due to a lack of relevant information on the topic. For instance, nine of the eighteen excluded articles did not draw any comparisons between physician- and nurse-led care in asthma patients. Some excluded resources did not provide a clear definition of asthma, as well as included some co-interventions that provided a distraction from the initial topic. To find a series of randomized control trials, the researcher conducted a review of available medical literature related to doctor-led and nurse-led care in patients with asthma. As a result, a review of the literature found five methodologically qualified studies that included 588 participants in total. However, based on the fact that the number of reviewed studies was quite small, it can only be cautiously asserted that health care provided by nurses may be the most effective for patients who have mild instances of asthma that can be controlled. This means that there is a lack of studies related to the subject, especially when it comes to investigating asthma control in different settings and the involvement of the healthcare costs (Kuethe et al., 2013, p. 2).
The study effectively presents the necessary points concerning the years of publication and the countries of origin of the reviewed studies, the type of patients involved, the severity of asthma in the reviewed articles, and primary and secondary outcomes.
The overall findings of the review did not present any significant differences between the nurse-led and physician-led healthcare based on the assessed studies. There were very few parameters found to provide evidence of the benefits of nurse-led health care over physician-led. It is important to note that the primary benefit of nurse-led care is linked to the ability to reduce the costs involved in healthcare delivery. Despite the relatively small number of available studies on the topic, the review found that nurse-led care can be easily applicable in patients who deal with mild instances of asthma that can be controlled. Since there was only one study included that involved uncontrolled patients, there is no clear information about whether nurse-led care can be implemented for patients with uncontrolled instances of asthma (Kuethe et al., 2013, p. 16).
Conclusions with Relation to Further Research
Thus, the primary conclusion is based on the fact that the study did not involve a large number of reviewed studies that presented in-depth information on nurse-led versus physician-led care in patients with asthma. Future research should put a thorough focus on the adverse effects of asthma. Further assessment and research are needed to evaluate the quality of nurse and physician care in a variety of settings at different stages of asthma progression. Since current practice greatly relies on the reduction of costs in the healthcare system and the provision of better quality care for patients, financing of asthma management should be further explored to find effective ways to improve care. Despite the lack of concise studies on nurse-led care offering a reduction in costs, the study managed to find parallels between the two aspects, thus presenting an encouraging prospect for future research. It is also important to note that the issue of cost reduction in nurse- and physician-led care is a primary focus in countries where the number of medical professionals is quite low. Thus, further research on this topic will be beneficial in many developing countries with low-quality health care.
Kuethe, M., Vaessen-Verberne, A., Elbers, R., & Van Aalderen, W. (2013). Nurse versus physician-led care for the management of asthma. Cochrane Database of Systematic Reviews, 2. 1-35.