Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Martínez-González, Nahara Anani; Djalali, Sima; Tandjung, Ryan; Huber-Geismann, Flore; Markun, Stefan; Wensing, Michel; Rosemann, Thomas

doi:10.1186/1472-6963-14-214

BMC Health Services Research

Table 2 Quality of methods in the studies included in review

From: Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Study details (country, design, funding)	Inclusion & exclusion criteria	Outcome		Sequence generation	Allocation concealment	Blinding	Sample size	Attrition %	Funding
Study details (country, design, funding)	Inclusion & exclusion criteria	1ry	2ry	Sequence generation	Allocation concealment	Blinding	Sample size	Attrition %	Funding
ZA 2	✓	✓	✓	A	A	NP^‡	✓^║	≥20^#	G
Fairall, 2012 [36] (Cohort 2)	✓	✓	✓	A	A	NP^‡	✓^║	≥20^#	G
ZA 1	✓^†	✓	✓	A	A	NP^‡	✓^║	≥20^#	G
Fairall, 2012 [36] (Cohort 1)	✓^†	✓	✓	A	A	NP^‡	✓^║	≥20^#	G
NL 6	✓^†	✓	✓	I	A	NP	✓	<20	G
Houweling, 2011 [30]	✓^†	✓	✓	I	A	NP	✓	<20	G
NL 5	✓^†	✓		A	A	NP	✓^¶	<20	NR
Kuethe, 2011 [25]	✓^†	✓		A	A	NP	✓^¶	<20	NR
RU 1	✓			U	I	^‡	✓^¶	≥20	None
Andryukhin, 2010 [46]	✓			U	I	^‡	✓^¶	≥20	None
NL 4	✓	✓		A	U	I^‡,§	✓	<20	P/Ind.
Voogdt-Pruis, 2010 [16]	✓	✓		A	U	I^‡,§	✓	<20	P/Ind.
NL 3	✓^†			A	A	NP	NP	≥20	G
Dierick-Van Dale, 2009 [39]	✓^†			A	A	NP	NP	≥20	G
UK 9	✓^†			A	A	NP^§	✓	<20^#	NR
Chan, 2009 [42]	✓^†			A	A	NP^§	✓	<20^#	NR
NL 2	✓^†	✓	✓	U	U	NP	✓^║	≥20	NR
Du Moulin, 2007 [37]	✓^†	✓	✓	U	U	NP	✓^║	≥20	NR
USA 6	^*			U	U	NP	NP	<20	G
Hiss, 2007 [32]	^*			U	U	NP	NP	<20	G
NL 1	^*	✓	✓	U	U	NP^§	✓^║	≥20	NR
Hesselink, 2004 [33]	^*	✓	✓	U	U	NP^§	✓^║	≥20	NR
UK 8	^*	✓	✓	I	I	NP	✓^¶	<20^#	NR
Denver, 2003 [40]	^*	✓	✓	I	I	NP	✓^¶	<20^#	NR
UK 7	✓	✓	✓	A	A	NP	✓	<20	P/Ind.
Jarman, 2002 [29]	✓	✓	✓	A	A	NP	✓	<20	P/Ind.
UK 6	^*†	✓	✓	A	U	U	✓	≥20^#	NR
Kernick, 2002 [27]	^*†	✓	✓	A	U	U	✓	≥20^#	NR
US 5	^*			U	U	NP	✓^¶	≥20	G
Mundinger, 2000 [22, 24]	^*			U	U	NP	✓^¶	≥20	G
UK 5	✓	✓		A	U	U	✓^¶	≥20	Ind.
Kernick, 2000 [28]	✓	✓		A	U	U	✓^¶	≥20	Ind.
UK 4	✓	✓	✓	A	A	NP	✓^║,¶	≥20	G
Kinnersley, 2000 [26]	✓	✓	✓	A	A	NP	✓^║,¶	≥20	G
UK 3	✓			A	A	NP	NR^║,¶	≥20	P
Venning, 2000 [17]	✓			A	A	NP	NR^║,¶	≥20	P
UK 2	✓			A	A	NP	✓^¶	≥20	G
Shum, 2000 [18]	✓			A	A	NP	✓^¶	≥20	G
US 4	✓			I	I	NP	NP	U	NR
Hemani, 1999 [34]	✓			I	I	NP	NP	U	NR
UK 1	✓			A	I	NP^§	✓	≥20^#	G
Campbell, 1998 [19–21, 41, 43–45]	✓			A	I	NP^§	✓	≥20^#	G
US 3	✓	✓		U	U	A^‡	NR	U	NR
Winter, 1981 [15]	✓	✓		U	U	A^‡	NR	U	NR
US 2	^*			U	U	NP	NR	<20	NR
Flynn, 1974 [35]	^*			U	U	NP	NR	<20	NR
US 1	^*			U	U	NP^§	NR	U^#	G
Lewis, 1967 [23]	^*			U	U	NP^§	NR	U^#	G

Legend.
Studies are listed by year (y) of publication, in decreasing order. Blinding: whether patients, care providers and outcome assessors were blinded. Attrition of more than 20% is of significant concern. Intention to treat (ITT) whether study authors analysed all patients based on their original group allocation regardless of protocol violations or non-compliance. US, United States; NL, The Netherlands; UK, United Kingdom; ZA, South Africa; RU, Russia; I, Inadequate; A: Adequate; U, Unclear; NP, Not Performed; NR, Not reported; Funding, Government (G), Industry (Ind.) or Private (P) grant.
^*Only the inclusion criteria was reported.
^†Not all factors tested at baseline were comparable between groups.
^‡Fairall et al. (2012) [36] partly blinded data analysts; Andryukhin et al. (2010) [46] blinded clinicians not patients; Voogdt-Pruis et al. (2010) [16] blinded patients not clinicians; Winter (1981) [15] blinded patients and clinicians.
^§Outcome assessors blinded for some or all outcomes.
^║Used a cluster effect approach (e.g. Huber-White).
^¶Reached the least target sample required to achieve power.
^#Used ITT strategies to deal with missing data.

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