Intervention Review

Specialist home-based nursing services for children with acute and chronic illnesses

  1. Carolyn Cooper1,*,
  2. Danielle M Wheeler2,
  3. Susan Woolfenden3,
  4. Trish Boss4,
  5. Susan Piper5

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 JUL 2005

DOI: 10.1002/14651858.CD004383.pub2

Database Title

Additional Information

How to Cite

Cooper C, Wheeler DM, Woolfenden S, Boss T, Piper S. Specialist home-based nursing services for children with acute and chronic illnesses. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004383. DOI: 10.1002/14651858.CD004383.pub2.

Author Information

  1. 1

    Royal North Shore Hospital, Level 5 Douglas Building, St Leonards, New South Wales, Australia

  2. 2

    Community Child Health, Sydney Children's Hospital, Cochrane Child Health Field, Randwick, New South Wales, Australia

  3. 3

    Liverpool Hospital, B Wing, Liverpool, NSW, Australia

  4. 4

    Sydney West Area Health Service, Clinical Nurse Consultant - Paediatrics, Penrith, NSW, Australia

  5. 5

    Wyong Hospital, Paediatric Ambulatory Care Unit, Wyong, New South Wales, Australia

*Carolyn Cooper, Level 5 Douglas Building, Royal North Shore Hospital, St Leonards, New South Wales, 2751, Australia. CCooper@nsccahs.health.nsw.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing trauma resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay.

Objectives

To evaluate specialist home-based nursing services for children with acute and chronic illnesses.

Search methods

Electronic searches were made of CENTRAL (Cochrane Central Register of Controlled Trials) 2005 (Issue 2); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); PsycINFO (1887 to August 2005); CINAHL (1982 to August 2005); Sociological Abstracts (1963 to August 2005). Optimally sensitive search strategies for randomised controlled trials (RCTs) were combined with medical subject headings and text words specific for ambulatory paediatrics, nursing outreach and 'hospital in the home', and no language restrictions were applied.

Selection criteria

RCTs of children aged 0-18 with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional medical care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs.

Data collection and analysis

Meta-analysis was not appropriate because of the clinical diversity and lack of common outcomes measures

Main results

1655 titles yielded 5 RCTs with a total of 771 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported improvements in child and parental anxiety; one study reported no significant difference in readmissions; two studies reported significantly fewer bed days; increased satisfaction was reported ; home care was more costly for service providers, but less expensive for parents.

Authors' conclusions

While current research does not provide definitive support for specialist home-based nursing services in reducing access to hospital services or length of stay, preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home-based care. Further trials are required, measuring health, satisfaction, service utilisation and long-term costs.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Specialist home-based nursing services for children with acute and chronic illnesses

Specialist paediatric home-based nursing services for children with acute and chronic illnesses can potentially reduce hospital admission and length of stay, enhance health care in the community and reduce stress for families at the time of their child's illness. This review examines five randomised controlled trials (RCTs) of children aged 0-18 with acute and or chronic illnesses allocated to specialist home-based nursing services compared with conventional medical care. Outcomes studied include utilisation of health care services, physical and mental health, satisfaction, adverse health outcomes and costs. Synthesis of the results of these RCTs was not appropriate because of heterogeneity in the types of service provided, the patients and outcome measures. Examination of the results of individual RCTs shows improved satisfaction with home-based care with no adverse impact on physical health outcomes for children. There is no evidence that specialist home-based nursing services reduce access to hospital services or length of stay. Further trials are required, measuring health, satisfaction, service utilisation and long-term cost evaluation.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對患有急慢性疾病的兒童之專科居家護理服務

專科小兒居家護理服務已被提案，作為一個可以減少入院治療造成的傷害，同時可加強基層醫療服務，並且減少住院時間的符合成本效益的方法。

目標

評估針對患有急慢性疾病的兒童之專科居家護理服務。

搜尋策略

我們以電子檢索搜尋了以下資料庫，包括CENTRAL (Cochrane Central Register of Controlled Trials) 2005年 (第2期) 、 MEDLINE (1966年至2005年8月) 、 EMBASE (1980年至2005年8月) 、PsycINFO (1887年至2005年8月) 、CINAHL (1982年至2005年8月) 、 Sociological Abstracts (1963年至2005年8月) 。我們以最敏感的搜索策略，並且特別針對包含行動小兒醫學，護理外展工作以及 ‘醫院在家中’ 的醫學主標題和內文搜尋隨機對照試驗(RCTs) 。沒有語言限制。

選擇標準

患有急慢性疾病的0至18歲的兒童，比較分配給專科居家護理服務、和傳統醫療服務的隨機對照試驗。結果指標包括健康照護系統的使用、身體和心理健康、滿意度、不良健康預後和成本。

資料收集與分析

由於臨床的差異性以及缺乏共同評估的結果指標，不適合做統合分析。

主要結論

1655篇標題中，產生了5個隨機對照試驗，總共771位受試者。受試者、介入和成果指標都有差異性。在健康的結果指標方面沒有顯著差異。有兩個研究指出兒童和家長的焦慮有改善，一個研究報告在再住院方面沒有顯著差異; 有兩個研究報告住院天數明顯減少; 滿意度則有提高; 居家照護對服務提供者來說成本較高，但對父母來說則較不昂貴。

作者結論

雖然目前的研究並沒有提供明確的證據，來支持專科居家護理服務可以減少就醫或住院時間，但初步結果顯示，並不會對身體健康預後有不良影響，而且有一些論文指出在有居家照護情形下，滿意度會提高。仍需要進一步的研究來評估健康、滿意度、服務使用和長期的成本。

翻譯人

本摘要由朱奕蓁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

針對患有急慢性病兒童的專科兒童居家護理服務，可能可以減少住院次數及時間，提升社區健康照護，並減少兒童患病時的家庭壓力。本篇評論檢視了5個隨機對照試驗 (RCTs) ，以0到18歲患有急慢性病的孩童為樣本，比較分配給特殊居家護理服務及傳統醫療照護。結果包括健康照護系統的使用、身體和心理健康、滿意度、不良健康預後和成本。由於其服務、病患及結果量測的異質性，這些隨機對照試驗的結果不適合合併。各別隨機試驗顯示使用家庭護理在滿意度上有改善，而且對孩童的生理健康方面沒有不良影響。目前沒有證據顯示特殊家庭護理服務能減少就醫或住院時間。我們需要進一步的試驗，討論健康、滿意度、系統使用及評估長期成本。

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