Examining nursing processes across primary care settings using the Chronic Care Model: An umbrella review

Context: While there is clear evidence that nurses can play a significant role in responding to populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a distinct category of nurse. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum.

Objective: To provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model approach.

Study Design and Analysis: Systematic review of systematic reviews published between 2005 and 2021 based on the recommendations of Joanna Briggs Institute. Assessment of methodological quality based on AMSTAR 2 tool.

Dataset: MEDLINE (Ovid), EMBASE (Ovid), CINAHL and EBM Reviews

Population Studied: primary care nurses

Intervention: nursing processes, defined as any activity, care, service, intervention performed by a primary care nurse

Outcome measures: outcome related to the patient’s condition (physical, psychological, cognitive) or to the delivery of care and services

Results: Twenty-six systematic reviews and meta-analysis were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with very little mention of the decision support and clinical information systems components.

Conclusions: Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources must be designed to support the care of all providers to optimize the full range of services provided to patients with chronic conditions.