Telehealth in patient care by advanced practice nurses: a systematic review

Costa, Isabelle Cristinne Pinto; Costa, Alice Silva; Garbuio, Danielle Cristina; Zamarioli, Cristina Mara; Eduardo, Aline Helena Apolloni; Carvalho, Emilia Campos de; Chaves, Erika de Cassia Lopes

doi:10.37689/acta-ape/2025AR0003141

Brazil

home Table of contents navigate_before previous current next navigate_next

home Table of contents

Review Article • Acta Paul Enferm 38 • 2025 • https://doi.org/10.37689/acta-ape/2025AR0003141i linkcopy

Telehealth in patient care by advanced practice nurses: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To analyze the results of application of telehealth in patient care by advanced practice nurses.

Methos This is a systematic review of intervention studies, in accordance with recommendations from the JBI and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was conducted on August 23, 2023, using the descriptors “telemedicine”, “nurse practitioner”, “patient care” and related keywords. Seven databases were accessed, such as LILACS, PubMed^®, CINAHL, Embase, Scopus, Cochrane Database of Systematic Reviews and Web of Science Core Collection. Clinical trials, randomized or not, pre-post testing or before and after studies, without restrictions on publication date or language, that answered the question/PICO “What is the result of the application of telehealth carried out by advanced practice nurses in patient care?”, were included. An analysis of methodological quality was carried out, only studies of moderate and high methodological quality were included, and it was not possible to perform a meta-analysis.

Results A total of 15 articles were selected, with a population of adult patients, older adults and family members of children with chronic diseases. Interventions involved phone calls, combinations of different devices or programs for education, monitoring or counseling. In 12 studies, positive effects were identified for the primary outcomes: costs; self-management of care, caregiver satisfaction with health management; quality of life, comfort, adaptation to treatment, functional recovery, clinical indicators and vital signs.

Conclusion The positive effects of using telehealth to obtain clinical data and care management and its safe use, evidenced in the present study, allow us to recommend it. PROSPERO Register: CRD42023465566

Database	Search strategy	Number of articles retrieved from databases
PubMed	(((((((telehealth) OR (telemedicine)) OR (telecare)) OR (tele-nursing)) OR (Remote Patient Monitoring)) OR (Mobile Devices)) AND ((((advanced practice nurse) OR (advanced practice registered nurse)) OR (nurse practitioner)) OR (clinical nurse specialist))) AND (((((((patient outcomes) OR (patient care)) OR (healthcare quality)) OR (clinical outcomes)) OR (outcome)) OR (care efficiency)) OR (patient satisfaction))	937
WoS	(“Telehealth” OR “Telemedicine” OR “Telecare” OR “Tele-nursing” OR “Remote Patient Monitoring” OR “Mobile Devices”) AND (“Advanced practice nurse” OR “Advanced practice registered nurse” OR “Nurse practitioner” OR “Clinical nurse specialist”) AND (“Patient outcomes” OR “Patient care” OR “Healthcare quality” OR “Clinical outcomes” OR “Outcome” OR “Care efficiency” OR “Patient satisfaction”)	62
Scopus	(TITLE-ABS-KEY (“Telehealth” OR “Telemedicine” OR “Telecare” OR “Tele-nursing” OR “Remote Patient Monitoring” OR “Mobile Devices”) AND TITLE-ABS-KEY (“Advanced practice nurse” OR “Advanced practice registered nurse” OR “Nurse practitioner” OR “Clinical nurse specialist”) AND TITLE-ABS-KEY (“Patient outcomes” OR “Patient care” OR “Healthcare quality” OR “Clinical outcomes” OR “Outcome” OR “Care efficiency” OR “Patient satisfaction”))	405
CINAHL	“Telehealth” OR “Telemedicine” OR “Telecare” OR “Tele-nursing” OR “Remote Patient Monitoring” OR “Mobile Devices” AND MH “Advanced Practice Registered Nurses” OR “Advanced practice nurse” OR “Advanced practice registered nurse” OR MH “Nurse Practitioners” OR “Nurse practitioner” OR MH “Clinical Nurse Specialists” OR “Clinical nurse specialist” AND “Patient outcomes” OR “Patient care” OR MH “Quality of Health Care” OR “Healthcare quality” OR “Clinical outcomes” OR MH “Outcomes (Health Care)” OR “Outcome” OR “Care efficiency” OR “Patient satisfaction”	155
COCHRANE	“Telehealth” OR “Telemedicine” OR “Telecare” OR “Tele-nursing” OR “Remote Patient Monitoring” OR “Mobile Devices” AND “Advanced practice nurse” OR “Advanced practice registered nurse” OR “Nurse practitioner” OR “Clinical nurse specialist” AND “Patient outcomes” OR “Patient care” OR “Healthcare quality” OR “Clinical outcomes” OR “Outcome” OR “Care efficiency” OR “Patient satisfaction”	70
EMBASE	(‘telemonitoring’/exp OR ‘telehealth’ OR ‘telemedicine’ OR ‘telecare’ OR ‘tele-nursing’ OR ‘remote patient monitoring’ OR ‘mobile devices’) AND (‘nurse practitioner’/exp OR ‘advanced practice nurse’ OR ‘advanced practice registered nurse’ OR ‘nurse practitioner’ OR ‘clinical nurse specialist’) AND (‘patient outcomes’ OR ‘patient care’ OR ‘healthcare quality’ OR ‘clinical outcomes’ OR ‘outcome’ OR ‘care efficiency’ OR ‘patient satisfaction’) AND [embase]/lim	295
LILACS (PORTUGUESE)	“Telemedicina” OR “Telemedicina” OR “Telecuidado” OR “Teleenfermagem” OR “Monitoramento Remoto de Pacientes” OR “Dispositivos Móveis” AND “Enfermeiro de prática avançada” OR “Enfermeiro registrado de prática avançada” OR “Enfermeiro praticante” OR “Especialista em enfermagem clínica” AND “Resultados do paciente” OR “Cuidado do paciente” OR “Qualidade dos cuidados de saúde” OR “Resultados clínicos” OR “Resultado” OR “Eficiência no cuidado” OR “Satisfação do paciente”	0
LILACS	“Telehealth” OR “Telemedicine” OR “Telecare” OR “Tele-nursing” OR “Remote Patient Monitoring” OR “Mobile Devices” AND “Advanced practice nurse” OR “Advanced practice registered nurse” OR “Nurse practitioner” OR “Clinical nurse specialist” AND “Patient outcomes” OR “Patient care” OR “Healthcare quality” OR “Clinical outcomes” OR “Outcome” OR “Care efficiency” OR “Patient satisfaction”	0
LILACS (SPANISH)	“Telemedicina” OR “Telemedicina” OR “Telecuidado” OR “Teleenfermería” OR “Monitoreo Remoto de Pacientes” OR “Dispositivos Móviles» AND “Enfermero de práctica avanzada” OR “Enfermero registrado de práctica avanzada” OR “Enfermero practicante” OR “Especialista en enfermería clínica” AND “Resultados del paciente” OR “Cuidado del paciente” OR “Calidad de la atención médica” OR “Resultados clínicos” OR “Resultado” OR “Eficiencia del cuidado” OR “Satisfacción del paciente”	O

Authors, country and year	Objective	Population and sample	Intervention	Expected primary and secondary outcomes	Main results
Randomized clinical trials
Cady et al. ⁽²⁶⁾ United States (2015)	Test the effectiveness of a care coordination model for children with medical complexities delivered by APN via telehealth.	Population: family members of children with complex clinical conditions Control group: conventional care, n=55 Intervention group: care coordination by telephone, n=54 Intervention group: care coordination via telephone associated with video, n=54	Telehealth (telephone or phone associated with video conferencing)	Primary: improved care coordination, need for help coordinating care, adequacy of help received for care coordination. Secondary: increased satisfaction with telehealth and quality of life.	In both intervention groups, there was a statistically significant increase throughout the study only in the adequacy of the help received for care coordination. The groups reported high levels of satisfaction with the care received, with a reduction in the need to seek healthcare services throughout the study (no statistical difference).
Stone et al.⁽²⁷⁾ United States (2010)	Compare the effectiveness of home telemonitoring associated with active medication management by a nurse with a low-intensity care coordination intervention for glycemic control in older adults with type 2 diabetes.	Population: older adults with type 2 diabetes Control group: low-intensity care coordination, n=72 Intervention group: home telemonitoring associated with active medication management by a nurse, n=64	Telemonitoring for home care management	Primary: change in glycated hemoglobin level, weight, blood pressure and lipids. Secondary: improved management of medications in use.	In both groups, levels of glycated hemoglobin, blood pressure, lipids (cholesterol, LDL and HDL) improved significantly compared to baseline. In the intervention group, there was a statistically significant reduction in glycated hemoglobin at 3 and 6 months, and LDL was significantly lower at 6 months. The other primary outcomes were similar between the groups. The intervention also provided a difference in the use of medications at 6 months of the study, with more medications or altered doses of antihypertensives, but not lipid-lowering or oral hypoglycemic agents. As for insulin, it provided more adjustments in the insulin dose and higher daily doses of insulin.
Hudson et al.⁽²⁸⁾ United States (2014)	Investigate whether adding telephone counseling to a paper survivorship care plan improves participation in cardiomyopathy screening of at-risk survivors.	Population: childhood cancer survivors at risk for cardiomyopathy, n=754 Control group: standard care, n=234 Intervention group: standard care associated with telephone counseling, n=238	Telephone counseling in two sessions	Primary: adherence to cardiomyopathies screening.	The intervention significantly increased the likelihood of screening for cardiomyopathy among at-risk childhood cancer survivors. Participants in the intervention group were more likely to identify concerns about insurance coverage for testing, and those in the control group were more likely to identify a lack of medical advice for not completing screening. Other reasons presented did not differ between the groups.
Looman et al.⁽²⁹⁾ United States (2015)	Assess the effect of telehealth care coordination performed by APN for children with complex clinical conditions (single and/or multiple).	Population: family members of children with complex clinical conditions Control group: conventional care, n=47 Intervention group: care coordination by telephone, n=50 Intervention group: care coordination via telephone associated with video, n=51	Telehealth (telephone or phone associated with video conferencing)	Primary: increased satisfaction of primary caregivers with healthcare services and the perception of the adequacy of the care received in relation to the care needed.	In the total sample, considering the number of complex conditions present in children and family members’ satisfaction with communication with healthcare services, there was a significant difference, and, in the group with children with multiple conditions, satisfaction was greater than in the group with children with multiple conditions. group with children with a single complex clinical condition The intervention was associated with higher family member ratings of caregivers, caregiver communication, overall healthcare, and adequacy of care coordination compared to individuals in the control group (statistically significant differences).
McKissick et al.⁽³⁰⁾ United States (2016)	Determine whether the intervention reduces the number of unplanned clinical visits and whether the effectiveness of video telehealth technology is superior to telephone-only telehealth.	Population: family members of children with complex clinical conditions Control group: conventional care, n=47 Intervention group: care coordination by telephone, n=50 Intervention group: care coordination via telephone associated with video, n=51	Telehealth (telephone or phone associated with video conferencing)	Primary: reducing the number of unplanned clinical visits.	The following differences were identified in the statistical test: - The number of unplanned visits decreased over time in all groups, with the greatest decrease in the video-linked telephone care coordination intervention group. - The number of planned visits was higher in the telephone care coordination group associated with video in all periods.
Wang et al.⁽³¹⁾ China (2018)	Assess the impact of an online home orthopedic care platform on functional recovery, quality of life and daily activities after hip arthroplasty.	Population: patients undergoing hip arthroplasty Control group: usual care, n=195 Intervention group: online platform, n=194	Telenursing for online monitoring	Primary: functional recovery of the hip; improvement in the performance of activities of daily living; increased health-related quality of life.	The outcome measurement levels of this study were significantly elevated in the telenursing group compared to the control group.
Wood et al.⁽³²⁾ Australia (2019)	Investigate the application’s contribution to search for care in patients with cystic fibrosis, facilitating early detection of exacerbations and enabling more immediate treatment.	Population: adults diagnosed with cystic fibrosis Control group: usual care, n=31 Intervention group: monitoring patients using the cell phone application (smartphone), n=29	Using an application on a smartphone	Primary: changes in the number of cycles and days of intravenous antibiotics. Secondary: use of healthcare; improvement in clinical data, quality of life, levels of anxiety and depression; adherence to treatment and absenteeism.	Smartphone application use was significantly effective in reducing the time between the detection of an exacerbation of the disease and starting the use of antibiotics, in reducing the use of intravenous antibiotics, which were replaced by oral antibiotics, and in increasing the number of contacts with a nurse. There was no difference between the intervention in secondary outcomes.
Leimiget al.⁽³³⁾ United States (2008)	Compare the occurrence of infection, rejection, and hospitalization in individuals randomized to telehealth or standard post-transplant care.	Population: patients undergoing transplants Control group: standard treatment, n=53 Intervention group: telehealth, n=53	Telehealth visit (using physical exam equipment)	Primary: occurrence of infection, transplant rejection and hospitalization.	No differences were found between groups for infections, rejections or hospitalizations at the study end point (6 months).
Kim et al.⁽³⁴⁾ Republic of Korea (2013)	Test the effectiveness of an educational intervention and telemonitoring in improving pain, anxiety, depression, anguish and quality of life in patients with advanced tumors.	Population: outpatients with advanced tumors with moderate to severe cancer-related pain Control group: educational intervention on pain management, n=54 Intervention group: educational intervention on pain management associated with telemonitoring, n=54	Pain telemonitoring	Primary: reduction in pain level. Secondary: improvement in levels of anguish, anxiety, depression, quality of life, performance of daily activities and clinical parameters.	Telemonitoring showed effectiveness in improving pain in 1 week, including pain levels indicated as worst and average intensities. There was a significant reduction in the proportion of patients whose pain scale was ≥4, in anxiety and depression and an improvement in quality of life (fatigue and insomnia) and in the performance of activities. There was no improvement in the level of suffering. Patient outcomes did not differ when examining primary cancer types.
Greving et al.⁽³⁵⁾ Netherlands (2015)	Assess the cost-effectiveness of a nurse-led online program for managing vascular risk factors added to usual care compared to usual care alone for patients with vascular disease.	Population: patients with atherosclerosis with clinical manifestations and two uncontrolled risk factors, n=330 Control group: usual care, n=166 Intervention group: online program based on a website associated with usual care, n= 164	Custom program (website)	Primary: improvement in cost-effectiveness. Secondary: improvement in quality of life.	Patients in both groups equally experienced health and quality of life benefits at 1 year. The intervention was associated with lower total costs (219 euros) over 1 year compared with usual care and had a small effect on vascular risk factors.
Vernooij et al.⁽³⁶⁾ Netherlands (2012)	Assess the effectiveness of an online nursing self-management program compared to conventional care in reducing vascular risk factors in patients with clinically manifest vascular disease.	Population: patients with atherosclerosis with clinical manifestations and two uncontrolled risk factors, n=330 Control group: usual care, n=166 Intervention group: online program based on a website associated with usual care, n= 164	Website-based online program	Primary: reduction in Framingham cardiac risk score. Secondary: changes in risk factor scores, proportions of patients achieving treatment goals.	When comparing the results obtained with the intervention in relation to the control group, the intervention promoted a statistically significant reduction in the Framingham cardiac risk score after 12 months, a reduction in cholesterol (LDL) levels and smoking.
Torbjørnsen et al.⁽³⁷⁾ Norway (2014)	Assess whether introducing technology-supported self-management using the Few Touch Application diabetes diary with or without health counseling contributes to improved glycated hemoglobin levels, self-management, behavior change and quality of life.	Population: people with type 2 diabetes, age ≥18 years and glycated hemoglobin level ≥7.1%, n=151 Control group: usual care, n=50 Intervention group: Few Touch Application use, n=51 Intervention group: Few Touch Application use with telephone counseling, n=50	Few Touch Application with and without telephone advice	Primary: change in glycated hemoglobin level, quality of life, behavior and cost-benefit. Secondary: improvement in people’s clinical characteristics and lifestyle.	There were no differences in glycated hemoglobin levels between groups after 4 months, but there was a decline in all groups. In both intervention groups, there were statistically significant changes in self-management using the application. In the group that used only the application, there was a significant improvement in acquisition of skills and techniques for managing symptoms compared to the control group. The other outcomes analyzed did not change.
Holmen et al.⁽³⁸⁾ Norway (2014)	Test whether a cell phone self-management system, used for one year, with or without telephone counseling for four months, contributes to improving glycated hemoglobin levels, self-management and quality of life compared to usual care.	Population: people with type 2 diabetes, age ≥18 years and glycated hemoglobin level ≥7.1%, n=151 Control group: usual care, n=50 Intervention group: Few Touch Application use, n=51 Intervention group: Few Touch Application use with telephone counseling, n=50	Few Touch Application with and without telephone advice	Primary: change in glycated hemoglobin level after 1 year. Secondary: improvement of self-management, quality of life.	The level of glycated hemoglobin decreased in all groups, but did not differ between them, after one year of study. The use of the application associated with health counseling showed an improvement (significant difference) in self-management of care and acquisition of skills and techniques for self-care compared to the other groups in the study. The other outcomes analyzed did not change.
Quasi-experimental studies
Hullick et al.⁽³⁹⁾ Australia (2022)	Determine whether adding video telehealth visits to the Aged Care Emergency program further reduces emergency room visits and hospital admissions.	Population: Nursing Homes within a catchment area of the hospital emergency department, n=1271 Control group: healthcare in hospital services, n=461 Intervention group: telehealth consultations with nurses when an acute condition was detected by the Nursing Home team and patient follow-up after initial care, n=201	Telehealth for changes in condition or hospital transfers	Primary: reduction in the number of hospital admissions. Secondary: reduction in emergency room visits.	There was a 2% reduction in hospitalizations among the institutions undergoing the intervention when compared to the period before the intervention was offered. Among institutions that did not receive the intervention, there was a 3% increase in hospitalizations. The difference between the groups was 5% less hospitalization for the intervention group. As for emergency service consultations, there was a reduction of 11% for the intervention group and 6% for the control group. The differences were not statistically significant
Bohnenka et al.⁽⁴⁰⁾ United States (2004)	Assess the impact of telenursing on patients discharged with ostomies resulting from oncological treatment in relation to cost, and on patient satisfaction and adaptation and self-care.	Population: individuals who, due to cancer treatment, required an ostomy, n=28 Population: people with ostomies, n=28 Control group: traditional home care, n=14 Intervention group: traditional home care and telenursing, n=14	Telenursing Visit	Primary: change of costs, patient satisfaction, and patient adjustment. Secondary: change in the number of days to exchange the independent exchange.	Both groups reported more than 80% satisfaction. Patients in the intervention group reported higher levels of satisfaction and comfort (statistically significant difference). There was no statistical difference between the groups for any item that assessed self-care and the measure of patient adjustment. Costs (consultation, scholarship and total cost) were equivalent between the groups. It is noteworthy that the control group needed one more consultation than the intervention group, but this group had 3.6 telenursing consultations in addition to traditional care. The number of days for independent exchange did not show statistically significant differences between the groups.

vertical_align_top file_download show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

rss_feed Stay informed of issues for this journal through your RSS reader

Accessibility / Report Error

[TFN1001] APN - advanced practice nurses; LDL - low density lipoprotein; HDL - high density lipoprotein.