This meta-analysis synthesized evidence from economic evaluations alongside randomized controlled trials to compare the impact of primary community health care nurses versus medical practitioners. The study population comprised 14,523 participants across primary community health care settings. The intervention involved care delivered by primary community health care nurses, while the comparator group consisted of medical practitioners. The analysis utilized a random-effects model to pool data, acknowledging the heterogeneity often present in such comparative effectiveness research.
Regarding patient health outcomes, the meta-analysis reported significant improvements across multiple domains when care was provided by primary community health care nurses. Depression scores showed a standardized mean difference of g -0.31, with a 95% confidence interval ranging from -0.47 to -0.15. Anxiety scores improved with a g effect size of -0.23, corresponding to a 95% confidence interval of -0.35 to -0.11. Fatigue levels decreased significantly, indicated by a g effect size of -0.26 and a 95% confidence interval of -0.45 to -0.07. Daily functioning also improved, with a g effect size of 0.08 and a 95% confidence interval of 0.03 to 0.12. Patient satisfaction scores increased with a g effect size of 0.25, supported by a 95% confidence interval of 0.08 to 0.42.
Physiological and resource utilization metrics further supported the efficacy of the nurse-led approach. Total cholesterol levels improved significantly, showing a g effect size of -0.38 with a 95% confidence interval of -0.71 to -0.06. Health resource utilization demonstrated marked efficiency gains. Outpatient visits decreased with a g effect size of -0.33 and a 95% confidence interval of -0.56 to -0.11. Hospitalization rates improved with a g effect size of -0.11, with a 95% confidence interval of -0.18 to -0.04. Length of stay reduced with a g effect size of -0.05 and a 95% confidence interval of -0.10 to -0.01. Generalist medical practitioner consultations decreased, indicated by a g effect size of -0.16 and a 95% confidence interval of -0.25 to -0.08.
Economic evaluations revealed substantial cost-effectiveness from both payer and societal perspectives. The incremental net monetary benefit for the payer perspective was US$910.99, with a 95% confidence interval of US$561.74 to US$1260.24. From a societal perspective, the incremental net monetary benefit was US$1485.2, with a 95% confidence interval of US$273.24 to US$2697.18. These figures indicate that the intervention is not only clinically effective but also economically advantageous compared to the comparator.
Safety and tolerability data were not reported in the source meta-analysis. Serious adverse events, discontinuations, and specific tolerability metrics were not reported. The study did not provide absolute numbers for adverse events, nor did it specify rates of discontinuation due to side effects. This lack of safety data represents a notable gap in the current evidence base regarding the comparative safety profiles of these two care delivery models.
Methodological limitations include the reliance on pooled data from diverse economic evaluations and randomized controlled trials. The study synthesized evidence from economic evaluations alongside randomized controlled trials, which may introduce heterogeneity in how outcomes were measured and reported. The follow-up period was not reported, which limits the ability to assess long-term sustainability of these effects. Funding or conflicts of interest were not reported for the included studies or the meta-analysis itself.
The clinical implications of these findings are significant for health systems aiming to achieve universal health coverage. Primary community health care nurses are a cost-effective solution for achieving universal health coverage and sustainable health care. They improve patient health and health resource utilization especially in reducing outpatient visits, hospitalization, length of stay. Strategic investment in their function is essential for advancing health equity and accessible, high-quality primary health care. These results suggest that shifting care delivery to include primary community health care nurses can yield substantial benefits for patients and health systems.
Several questions remain unanswered regarding the long-term durability of these effects. The lack of reported follow-up periods prevents clinicians from knowing how long these improvements in depression, anxiety, and resource utilization persist. Additionally, the absence of safety data means that clinicians cannot fully assess the risk-benefit profile of relying on primary community health care nurses versus medical practitioners in all contexts. Future research should aim to address these gaps by reporting comprehensive safety data and longer-term follow-up outcomes.
