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


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


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.


METHODS
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.


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


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.


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.
Cooper
C
C
Fairfield Health Service, P.O. Box 5, Fairfield, New South Wales, Australia. CCooper@nsccahs.health.nsw.gov.au
Wheeler
D M
DM
Woolfenden
S R
SR
Boss
T
T
Piper
S
S
D000208:Acute Disease / Q000451:nursing*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000451:nursing*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration / Q000592:standards; D006701:Home Nursing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic