An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review
Open accessAbstract
Nurses are key to the delivery of global primary health care services. However, there appears to be a lack of evaluation of primary health care nursing delivery models in the published literature. This evaluation is vital to the improvement of patient experiences, national and global health outcomes, and the justification of future investment in primary health care nursing services. The purpose of this review was to explore and analyze the literature that reports on the evaluation of primary health care nursing services, to ascertain the nature and utility of these evaluation methods, and identify opportunities for future research in this area. A systematic review of the published literature was conducted following PRISMA guidelines, using the databases CINAHL, Joanna Briggs Institute, MEDLINE, and Proquest. Thirty‐two articles published between 2010 and 2022 were selected. Results were organized using the Donabedian model. A paucity of research into the evaluation of nurse‐led primary health care services was noted. Where evident, evaluation of primary health care nursing services tended to reflect the medical model. Medical outcomes measures dominated evaluation criteria including diagnosis rates, prescription costs, and disease outcomes. Primary health care principles such as service accessibility, cultural appropriateness, and availability were rarely used. The perspectives and experiences of nurses were not sought in service evaluation, including most of the nurse‐led services. Development of an evidence‐base of nursing primary health care services that are informed by the nursing experience and apply a framework of universal primary health care principles across the structure, process, and outcomes aspects of the service is recommended.
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Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.
“Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.8,11,18-26”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [22]
The Results (Study design and rigor; page unavailable) rate the included studies at three stars or higher, supporting the research-quality part of the claim. But the Abstract and Discussion (A need for nurse-led service model evaluation; pages unavailable) emphasize limited evaluation of nurse-led services and do not conclude that nursing-intensive primary care models have been shown to be safe and effective. (LLM, conf=0.85)
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Evaluating the quality of medical care
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“Ignoring factors such as the cultural appropriateness, cost and setting of a screening service limits the usefulness and meaningfulness (the why?) of the outcome findings (Penchansky & Thomas, 1981).”
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“Rigorous evidence of the quality of care is needed if policy makers are to make informed decisions about health care delivery models (Laurant et al., 2018).”
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“PHC scholars argue that quality measurement of a PHC service must involve the interplay between service structure, process, and outcome (Arvidsson et al., 2019; Berwick, 1989; Berwick & Fox, 2016).”
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“…of America (Buerhaus et al., 2018; Christiansen et al., 2016; Coddington et al., 2011; Farford et al., 2021; Jennings et al., 2016; Kinder, 2016; Kurtzman & Barnow, 2017; Mitchell et al., 2019; Poghosyan et al., 2018; Reuben et al., 2013; Wenger et al., 2011); four studies in the United Kingdom…”
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BackgroundInfluentialLearning how to undertake a systematic review: part 1
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“All discussed the rigor of their study design, but none described the theory or literature used to inform question development (Fischer et al., 2015; McCullough et al., 2020; Stenner et al., 2011).”
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BackgroundMethodInfluentialEffectiveness of registered nurses on system outcomes in primary care: a systematic review
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“…et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman & Barnow, 2017; McCullough et al., 2020; Rabie et al., 2016; Rawat et al., 2018; Vasan et al., 2013; Vestjens et al., 2019; Webb et al., 2019; Wenger et al., 2011).”
BackgroundInfluentialMapping primary care in Australia
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Learning how to undertake a systematic review: part 2
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“Mitchell et al. (2019) for example, evaluated a primary care model in Minnesota USA, which considered staff quality of life and safety culture within the team (process), and patient experience, cancer screening targets, and care costs (outcome).”
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“…2018; Christiansen et al., 2016; Gysin et al., 2020; Jennings et al., 2016; Prestes et al., 2017; Reuben et al., 2013), diabetes control (Christiansen et al., 2016; Prestes et al., 2017), obesity levels (Lawson et al., 2012) and maternal postpartum morbidity and mortality (Fischer et al., 2015).”
BackgroundMethodInfluentialE.A. Codman and the Rhetoric of Battle: A Commentary
Berwick, D. M. (1989) · Milbank Quarterly · doi:10.2307/3350141 · Cited by 35 · see citing works
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“Just 3 studies evaluated their service using both approaches (Faulkner et al., 2016; Harris et al., 2015; Mitchell et al., 2019).”
BackgroundInfluentialBurton, C. W. (2020) · Advances in Nursing Science · doi:10.1097/ans.0000000000000319 · Cited by 29 · see citing works
Lawson, B. J., Dicks, D., MacDonald, L., & Burge, F. (2012) · Nursing leadership · doi:10.12927/cjnl.2013.23057 · Cited by 24 · cited 7× · see citing works
“…2018; Christiansen et al., 2016; Gysin et al., 2020; Jennings et al., 2016; Prestes et al., 2017; Reuben et al., 2013), diabetes control (Christiansen et al., 2016; Prestes et al., 2017), obesity levels (Lawson et al., 2012) and maternal postpartum morbidity and mortality (Fischer et al., 2015).”
BackgroundInfluentialNurses' Perceptions of Quality Care
Ryan, C. J., Powlesland, J., Phillips, C., Raszewski, R., Johnson, A., Banks-Enorense, K., Agoo, V. C., Nacorda-Beltran, R., Halloway, S., Martin, K., et al. (2016) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000211 · Cited by 23 · cited 1× · see citing works
“The finding that nurses were less frequently asked to contribute their perspectives and experiences within the evaluation of the care they provide concurs with a previous literature review (Ryan et al., 2017).”
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Quality Indicators for Primary Health Care
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“This focus, to the exclusion of structures and processes, appears common in PHC service evaluation literature (see Lukewich et al., 2022; Simou et al., 2015).”
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“…et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman & Barnow, 2017; McCullough et al., 2020; Rabie et al., 2016; Rawat et al., 2018; Vasan et al., 2013; Vestjens et al., 2019; Webb et al., 2019; Wenger et al., 2011).”
BackgroundInfluentialQuality of Care Provided in a Special Needs Plan Using a Nurse Care Manager Model
Wenger, N. S., Roth, C. P., Martin, D., Nickels, L. D., Beckman, R., KAMBERG, C. J., Mach, J. R., & Ganz, D. A. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03599.x · Cited by 19 · cited 7× · see citing works
“…et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman & Barnow, 2017; McCullough et al., 2020; Rabie et al., 2016; Rawat et al., 2018; Vasan et al., 2013; Vestjens et al., 2019; Webb et al., 2019; Wenger et al., 2011).”
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“…et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman & Barnow, 2017; McCullough et al., 2020; Rabie et al., 2016; Rawat et al., 2018; Vasan et al., 2013; Vestjens et al., 2019; Webb et al., 2019; Wenger et al., 2011).”
BackgroundInfluentialRevenue effects of practice nurse-led care for chronic diseases
Iles, R. A., Eley, D. S., Hegney, D. G., Patterson, E., Young, J., Mar, C. D., Synnott, R. L., & Scuffham, P. (2014) · Australian Health Review · doi:10.1071/ah13171 · Cited by 17 · cited 16× · see citing works
“The review question asked, “ What evaluation frameworks have been used to assess PHC nursing services and how useful are they in the Australian PHC context?”
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“…were set in PHC settings such as remote community nursing services and urban community health centers and home visits (Abrahamsson et al., 2015; Christiansen et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman &…”
BackgroundInfluentialTHE NATURE OF COMMUNITY HEALTH CARE CENTRE PRACTICE ENVIRONMENTS IN A PROVINCE IN SOUTH AFRICA
Rabie, T., Coetzee, S. K., & Klopper, H. C. (2016) · Africa Journal of Nursing and Midwifery · doi:10.25159/2520-5293/216 · Cited by 17 · cited 9× · see citing works
“Examples of structure evaluation include the availability of equipment in setting needed for quality diabetic care in community (Webb et al., 2019) and the geographical location of an HIV PHC service (Rabie et al., 2016).”
BackgroundMethodInfluentialFarford, B. A., Baggett, C. L., Molina, C. S. P., Ball, C. T., & Dover, C. M. (2020) · Journal of Applied Gerontology · doi:10.1177/0733464820947928 · Cited by 17 · cited 3× · see citing works
“4 | Health service type and leadership Just 12 studies evaluated nurse‐led services, the nurses being registered community or clinic/practice nurses (Azariah et al., 2013; Coddington et al., 2011; Dufour et al., 2020; Farford et al., 2021; Fischer et al., 2015; Harris et al., 2015; Kosteniuk et al., 2017; Poghosyan et…”
BackgroundAzariah, S., McKernon, S., & Werder, S. F. (2013) · Journal of Primary Health Care · doi:10.1071/hc13141 · Cited by 16 · cited 5× · see citing works
“These included screening rates (Azariah et al., 2013; Buerhaus et al., 2018; Christiansen et al., 2016; Gysin et al., 2020; Jennings et al., 2016; Prestes et al., 2017; Reuben et al., 2013), diabetes control (Christiansen et al., 2016; Prestes et al., 2017), obesity levels (Lawson et al., 2012) and…”
BackgroundInfluentialKinder, F. D. (2016) · PubMed · Cited by 16 · see citing works
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“…2018; Christiansen et al., 2016; Gysin et al., 2020; Jennings et al., 2016; Prestes et al., 2017; Reuben et al., 2013), diabetes control (Christiansen et al., 2016; Prestes et al., 2017), obesity levels (Lawson et al., 2012) and maternal postpartum morbidity and mortality (Fischer et al., 2015).”
BackgroundInfluentialMeasuring quality in primary healthcare – opportunities and weaknesses
Arvidsson, E., Dijkstra, R. F., & Klemenc–Ketiš, Z. (2019) · Slovenian Journal of Public Health · doi:10.2478/sjph-2019-0013 · Cited by 14 · cited 1× · see citing works
“PHC scholars argue that quality measurement of a PHC service must involve the interplay between service structure, process, and outcome (Arvidsson et al., 2019; Berwick, 1989; Berwick & Fox, 2016).”
BackgroundGysin, S., Meier, R., van Vught, A., Merlo, C., Gemperli, A., & Essig, S. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01240-8 · Cited by 14 · cited 8× · see citing works
“These included screening rates (Azariah et al., 2013; Buerhaus et al., 2018; Christiansen et al., 2016; Gysin et al., 2020; Jennings et al., 2016; Prestes et al., 2017; Reuben et al., 2013), diabetes control (Christiansen et al., 2016; Prestes et al., 2017), obesity levels (Lawson et al., 2012) and…”
BackgroundInfluentialQuality of health care provided at a pediatric nurse‐managed clinic
Coddington, J. A., Sands, L. P., Edwards, N. E., Kirkpatrick, J. M., & Chen, S. E. (2011) · Journal of the American Academy of Nurse Practitioners · doi:10.1111/j.1745-7599.2011.00657.x · Cited by 13 · cited 9× · see citing works
“The majority ( n = 11) were carried out in the United States of America (Buerhaus et al., 2018; Christiansen et al., 2016; Coddington et al., 2011; Farford et al., 2021; Jennings et al., 2016; Kinder, 2016; Kurtzman & Barnow, 2017; Mitchell et al., 2019; Poghosyan et al., 2018; Reuben et al., 2013;…”
BackgroundInfluentialAbrahamsson, B., Berg, M.-L. U., Jutengren, G., & Jönsson, A. (2015) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzv017 · Cited by 12 · cited 5× · see citing works
“…and one in India (Fischer et al., 2015), Slovenia (Klemenc ‐ Ketis & Poplas ‐ Susi č , 2017), The Netherlands (Vestjens et al., 2019), Sweden (Abrahamsson et al., 2015), Rwanda (Vasan et al., 2013), Argentina (Prestes et al., 2017), New Zealand (Azariah et al., 2013), and Switzerland (Gysin…”
BackgroundInfluentialKosteniuk, J. G., Stewart, N. J., Karunanayake, C. P., Wilson, E. C., Penz, K. L., Kulig, J. C., Kilpatrick, K., Martin‐Misener, R., Morgan, D., & MacLeod, M. (2017) · Primary Health Care Research & Development · doi:10.1017/s146342361700038x · Cited by 12 · cited 6× · see citing works
“…nurses (Azariah et al., 2013; Coddington et al., 2011; Dufour et al., 2020; Farford et al., 2021; Fischer et al., 2015; Harris et al., 2015; Kosteniuk et al., 2017; Poghosyan et al., 2018; Vasan et al., 2013), nurse practitioners (Kinder, 2016; Stenner et al., 2011), or both (McCullough…”
BackgroundInfluentialMeasurement and Validation of Primary Care Nursing Indicators Based on a Wound Care Tracer Condition
Dufour, É., Duhoux, A., & Contandriopoulos, D. (2019) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000403 · Cited by 12 · cited 5× · see citing works
“…evaluated nurse ‐ led services, the nurses being registered community or clinic/practice nurses (Azariah et al., 2013; Coddington et al., 2011; Dufour et al., 2020; Farford et al., 2021; Fischer et al., 2015; Harris et al., 2015; Kosteniuk et al., 2017; Poghosyan et al., 2018; Vasan et al.,…”
BackgroundInfluentialKlemenc–Ketiš, Z., & Poplas‐Susič, A. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.14002 · Cited by 8 · cited 6× · see citing works
“…et al., 2012); three in South Africa (Rabie et al., 2016; Rawat et al., 2018; Webb et al., 2019); and one in India (Fischer et al., 2015), Slovenia (Klemenc ‐ Ketis & Poplas ‐ Susi č , 2017), The Netherlands (Vestjens et al., 2019), Sweden (Abrahamsson et al., 2015), Rwanda (Vasan et al., 2013),…”
BackgroundInfluentialRawat, A., Uebel, K., Moore, D. M., Cingl, L., & Yassi, A. (2018) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/j.jana.2018.04.014 · Cited by 8 · cited 8× · see citing works
“Fifteen studies were set in PHC settings such as remote community nursing services and urban community health centers and home visits (Abrahamsson et al., 2015; Christiansen et al., 2016; Coddington et al., 2011; Dufour et al., 2020; Fischer et al., 2015; Kosteniuk et al., 2017; Kinder, 2016; Kurtzman & Barnow, 2017;…”
BackgroundInfluentialCorrection: Diabetes Care Provision in UK Primary Care Practices
Hawthorne, G., Hrisos, S., Stamp, E., Elovainio, M. J., Francis, J., Grimshaw, J., Hunter, M., Johnston, M., Presseau, J., Steen, N., et al. (2012) · PLoS ONE · doi:10.1371/annotation/1957ad3b-e192-4faa-bf4c-5dce22c5560e · Cited by 2 · cited 3× · see citing works
“…centers of care (Azariah et al., 2013; Buerhaus et al., 2018; Farford et al., 2021; Faulkner et al., 2016; Gysin et al., 2020; Harris et al., 2015; Hawthorne et al., 2012; Iles et al., 2014; Jennings et al., 2016; Karnon et al., 2013; Klemenc ‐ Ketis & Poplas ‐ Susi č , 2017; Lawson et al.,…”
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- Authors
- McCullough, K., Andrew, L., Genoni, A., Dunham, M., Whitehead, L., & Porock, D.
- Affiliations
- Edith Cowan University (AU)
- Corresponding author
- Andrew, Lesley
- Venue
- Research in Nursing & Health
- Publisher
- Wiley
- Published
- 2022-12-25
- Volume
- 46
- Issue
- 1
- Pages
- 159-176
- ISSN
- 0160-6891 (ISSN-L)
- 1098-240X
- PMC
- PMC10107523
- OpenAlex
- W4312140500
- Cited by
- 43
- References
- 53
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 13 · 2023: 7 · 2022: 1
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Research in Nursing & Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Australasian Journal of Paramedicine (submittedVersion, cc-by)
- Funders
- Edith Cowan University
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- primary care nursing, service evaluation, Donabedian model, nurse-led services, evaluation criteria, biomedical model, access to services, cultural appropriateness, nursing perspective, health outcomes
- MeSH terms
- Humans, Primary Health Care
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