The Quality and Effectiveness of Care Provided by Nurse Practitioners
TL;DR: Evidence indicated better serum lipid levels in patients cared for by NPs in primary care settings and that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs.
About: This article is published in The Journal for Nurse Practitioners.The article was published on 2013-09-01. It has received 238 citations till now. The article focuses on the topics: Health care quality & Emergency department.
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Journal Article•
1,347 citations
TL;DR: There were few differences in primary care provided by APNs and physicians; for some measures APN care was superior; these data suggest that the APN workforce is well-positioned to provide safe and effective primary care.
Abstract: Purpose: To conduct a systematic review of randomized controlled trials (RCTs) of the safety and effectiveness of primary care provided by advanced practice nurses (APNs) and evaluate the potential of their deployment to help alleviate primary care shortages. Data sources: PubMed, Medline and the Cumulative Index to Nursing and Allied Health Literature. Study selection: RCTs and their follow-up reports that compared outcomes of care provided to adults by APNs and physicians in equivalent primary care provider roles were selected for inclusion. Data extraction: Ten articles (seven RCTs, plus two economic evaluations and one 2-year follow-up study of included RCTs) met inclusion criteria. Data were extracted regarding study design, setting and outcomes across four common categories. Results of data synthesis: The seven RCTs include data for 10 911 patients who presented for ongoing primary care (four RCTs) or same-day consultations for acute conditions (three RCTs) in the primary care setting. Study follow-up ranged from 1 day to 2 years. APN groups demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction and cost. APNs generally had longer consultations compared with physicians; however, two studies reported that APN patients required fewer consultations over time. Conclusion: There were few differences in primary care provided by APNs and physicians; for some measures APN care was superior. While studies are needed to assess longer term outcomes, these data suggest that the APN workforce is well-positioned to provide safe and effective primary care.
216 citations
Cites result from "The Quality and Effectiveness of Ca..."
...The results of this systematic review are generally consistent with the conclusions of earlier reviews [14, 16, 17, 21]....
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...Similarly, a review published in 2013 also included observational studies and studies in which the APN and physician were in non-equivalent or team-based roles [17], and a 2014 review investigated outcomes of nurse prescribing but included non-RCTs and a variety of care settings and specializations [14]....
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TL;DR: This work found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16, and found states with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice.
Abstract: The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008–16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care de...
155 citations
TL;DR: In the U.S. primary care practice of the future, the physician's role will increasingly be played by nurse practitioners, and the 150 million adults with one or more chronic conditions will receive some of their care from registered nurses functioning as care managers.
Abstract: In the U.S. primary care practice of the future, the physician's role will increasingly be played by nurse practitioners, and the 150 million adults with one or more chronic conditions will receive some of their care from registered nurses functioning as care managers.
90 citations
TL;DR: A national sample of 698 licensed NPs who graduated between 2006 and 2011 and were practicing as NPs in the United States completed a survey related to clinical preparation and practice transition.
86 citations
References
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TL;DR: An instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research is described and its use to determine the effect of rater blinding on the assessments of quality is described.
15,740 citations
"The Quality and Effectiveness of Ca..." refers methods in this paper
...The Jadad scale (designed for RCTs that use double-blinding, etc), which quantifies the presence or absence of certain design characteristics, is commonly used to assess quality.(30) A modified quality scale informed by the Jadad scale was developed to better assess the quality of studies (both...
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TL;DR: A system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts is developed, and a summary of the approach from the perspective of a guideline user is presented.
Abstract: Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations Systematic and explicit methods of making judgments can reduce errors and improve communication We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts In this article we present a summary of our approach from the perspective of a guideline user Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk It is also important to consider costs (resource utilisation) before making a recommendation Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues
7,608 citations
"The Quality and Effectiveness of Ca..." refers methods in this paper
...Strength of the aggregated evidence was graded a second time using an adapted GRADE Working Group Criteria.(31) This process provided a systematic, transparent, and “explicit approach to making judgments about the quality of evidence and the strength of recommendation....
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...Strength of the aggregated evidence was graded a second time using an adapted GRADE Working Group Criteria.31 This process provided a systematic, transparent, and “explicit approach to making judgments about the quality of evidence and the strength of recommendation.”...
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TL;DR: A review of the literature on quality assessment of medical care can be found in this article, where the authors focus almost exclusively on the evaluation of the medical care process at the level of physician-patient interaction.
Abstract: This p aper i s a n a ttempt t o d escribe a nd evaluate current methods for assessing the quality of medical care and to suggest some directions for further study. It is concerned with methods rather than findings, and with an evaluation of methodology in general, rather than a detailed critique of methods in specific studies. This is not an exhaustive review of the pertinent literature. Certain key studies, of course, have been included. Other papers have been selected only as illustrative examples. Those omitted are not, for that reason, less worthy of note. This paper deals almost exclusively with the evaluation of the medical care process at the level of physician-patient interaction. It excludes, therefore, processes primarily related to the effective delivery of medical care at the community level. Moreover, this paper is not concerned with the administrative aspects of quality control. Many of the studies reviewed here have arisen out of the urgent need to evaluate and control the quality of care in organized programs of medical care. Nevertheless, these studies will be discussed only in terms of their contribution to methods of assessment and not in terms of their broader social goals. The author has remained, by and large, in the familiar territory of care provided by physicians and has avoided incursions into other types of
5,020 citations
TL;DR: It is concluded that nurses entering the field are not equipped with the essential knowledge and skills for today's practice nor prepared to continue learning for tomorrow's nursing.
Abstract: The Carnegie Foundation for the Advancement of Teaching joins a chorus of calls for transformation of prelicensure nursing education (Benner, Sutphen, Leonard, & Day, 2009). Citing the shift of significant responsibility to nurses for managing complex medical regimens, as well as the increasing complexity of community-based practices, Benner and colleagues concluded that nurses entering the field are not equipped with the essential knowledge and skills for today's practice nor prepared to continue learning for tomorrow's nursing (p. 31). They found: a) weak curricula in natural sciences, technology, social sciences, and humanities, and in developing cultural competency; b) weak classroom instruction and limited integration between classroom and clinical experiences; c) limited strategies in helping students develop habits of inquiry, raising clinical questions, seeking evidence for practices; d) faculty and student perception that students are ill prepared for their first job and dissatisfaction with the teaching preparation of current nursing faculty; and e) multiple pathways to eligibility for the licensure examination, with tremendous variability in prerequisites, curricular requirements, and the quality of offerings.
2,186 citations
Journal Article•
1,347 citations
"The Quality and Effectiveness of Ca..." refers background in this paper
...Donabedian, the father of health care quality, suggested that care quality could be improved by establishing standards for care structures and processes.(11) Patient outcomes become the ultimate measures of quality as they reflect the influence of both structures and processes of care....
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