Nurse-Managed Protocols Improved Outpatient Care in Chronic Illnesses

(HealthDay News) — Team care involving nurse-managed protocols is one model that may improve outpatient care for adults with chronic conditions, according to research published in the Annals of Internal Medicine.

Ryan J. Shaw, PhD, RN, of the Durham Veterans Affairs Medical Center in North Carolina, and colleagues conducted a systematic review of the literature and a meta-analysis of data from 18 studies. The researchers sought to assess the effects of nurse-managed protocols on the outpatient management of adults with diabetes, hypertension and hyperlipidemia.

All of the studies involved a registered nurse, or equivalent, who titrated medications according to a protocol.

The researchers found that outpatients with diabetes receiving care under nurse-managed protocols experienced a 0.4% decrease in HbA1c (eight patients; 95% CI, 0.1-0.7). Those with hypertension (12 patients) experienced decreases in systolic and diastolic blood pressure of 3.68 mm Hg (95% CI, 1.05-6.31) and 1.56 mm Hg (95% CI, 0.36 to 2.76 mm Hg), respectively.

Individuals with hyperlipidemia had changes in lipid levels, including a 9.37-mg/dL decrease in total cholesterol level (nine patients; 95% CI, 20.77-mg/dL decrease to 2.02-mg/dL increase) and a 12.07-mg/dL decrease in LDL cholesterol level (six patients; 95% CI, 28.27-mg/dL decrease to 4.13-mg/dL increase).

“We need new models of primary care, and enlisting nurses will be central to this effort,” wrote the authors of an accompanying editorial. “Recognizing that nurse-managed protocols work for common outpatient diseases may be one step toward solving America’s primary care problem.”


  1. Shaw RJ et al. Ann Intern Med. 2014;161(2):113-121.
  2. Jauhar S et al. Ann Intern Med. 2014;161(2):153-154.