Nursing interventions for patients with chronic conditions.

BACKGROUND Maintaining independence in older people or restoring and encouraging self-management in those with chronic conditions are ways of increasing health-related quality of life and at the same time may achieve cost savings. Nurses often carry out these types of interventions in follow-up home visits. AIMS To describe nursing interventions during home visits and their effects on people suffering from a range of chronic conditions. METHOD A structured descriptive review was carried out using the Medline, Embase, PsycINFO, CINAHL and Cochrane databases and the terms chronic or diabetic or arthrit* or pain and randomi* and [(nurs* and care) or (nurs* and interventions)]. FINDINGS In older people the best outcomes are reached if the target population is 'the younger-old', or if intervention is tailored to elders who have stated health problems. The effect depends on the duration of the follow-up period, number of follow-up visits and personality of the nurse. Follow-up nursing interventions for patients with diabetes can improve psychosocial and health outcomes. Education of health providers and amount of time spent with patients seem to be important for positive outcome. A rheumatology nurse specialist seems to provide equally good clinical results as a rheumatologist and produces better patient-related outcomes. Compared with a multidisciplinary team treating patients in day care or inpatient settings, a rheumatology nurse specialist provides less patient satisfaction, but equally good clinical outcomes. CONCLUSIONS Patients with chronic conditions often benefited from follow-up visits by nurses. Visits should be multiple, extended over a long-term, and interventions should be individualized. The outcomes may be described as patient satisfaction, good clinical outcomes and cost savings. Future randomized controlled trials should describe nurses' interventions and educational background to enable replication. Randomized controlled trials using the Health Technology Assessment method would permit comparison between studies and be a good foundation for future decision-making.