Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions

Reuben, David B.; Ganz, David A.; Roth, Carol P.; McCreath, Heather; Ramírez, Karina D.; Wenger, Neil S.

doi:10.1111/jgs.12268

Cited by 56 publications

(93 citation statements)

References 20 publications

(41 reference statements)

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“…Four studies evaluated and compared how NP-physician co-management of patient care impact compliance with completing recommended care guidelines (Ganz et al, 2010; Litaker et al, 2003; Ohman-Strickland et al, 2008; Reuben et al, 2013). In patients with hypertension, elevated cholesterol, and/or diabetes, several diagnosis-specific care guidelines are recommended to improve the quality of care delivered by the PCP in an effort to improve patient outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…In patients with hypertension, elevated cholesterol, and/or diabetes, several diagnosis-specific care guidelines are recommended to improve the quality of care delivered by the PCP in an effort to improve patient outcomes. For example, Reuben et al (2013) found that 71% of overall recommended guidelines were completed with NP-physician co-management compared to 35% completed by a single physician ( p <.001). This study was rated by the researchers as high quality, with limited bias identified.…”

Section: Resultsmentioning

confidence: 99%

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Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care

Norful

Swords

Marichal

et al. 2019

Health Care Manage Rev

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Background The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse Practitioner (NP)-physician co-management of primary care patients has been proposed by some policymakers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP-physician co-management in primary care. Purpose This is the first review to synthesize all available studies that compare the effects of NP-physician co-management to an individual physician managing primary care. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed and inclusion/exclusion criteria applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black’s quality checklist for randomized and nonrandomized studies. Results Six studies were identified for synthesis. Three outcome categories emerged: 1) PCP adherence to recommended care guidelines; 2) empirical changes in clinical patient outcomes; and 3) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP-physician co-management. There was variability of clinical patient outcomes with some findings favoring the co-management model. Limited differences in patient quality of life were found. Across all studies, the NP-physician co-management care delivery model was determined to produce no detrimental effect on measured outcomes, and in some cases, was more beneficial in reaching practice and clinical targets. Practice Implications The use of NP-physician co-management of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP-physician interactions and processes to isolate the attributes of a successful NP-physician co-management model.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care

Norful

Swords

Marichal

et al. 2019

Health Care Manage Rev

View full text Add to dashboard Cite

show abstract

“…More recently, a study found that elderly patients reported statistically similar satisfaction levels with care regardless of whether their primary provider was a NP or a physician [37]. Another study found that, in community based practices, geriatric patients receiving PCP-NP co-managed care had better outcomes than those receiving care from a PCP only [38].…”

Section: Discussionmentioning

confidence: 94%

Nurse Practitioners in Physician Practices: Implications for Member Satisfaction

Guerard¹,

Omachonu²,

Harvey³

et al. 2016

J Hosp Med Manage

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Background: There is limited information about how Nurse Practitioners can affect patient satisfaction among elderly patients. This study considered the implications of assigning in-office Medicare Advantage (MA) plan Nurse Practitioners (NPs) in Primary Care Physician (PCP) practices which were affiliated with the (MA) plan. Specifically, this was a baseline study that explored whether the presence of an NP in the PCP practice was associated with improved satisfaction of members of the MA plan with their PCP, and whether member satisfaction with their PCP was associated with satisfaction with the MA plan.Methods: Self-reported, cross-sectional data previously collected by the MA organization from enrollees was linked to data on participating PCPs. Twentytwo percent of responding members had a PCP with an NP in the practice. Multivariate logistic regression models were estimated to find the association between presence of in-office NPs and a 'high' member rating of the PCP, and the association between 'high' rating of PCP and 'high' rating of MA plan. Findings:PCPs with in-office NPs were four percentage-points more likely to be rated highly by members (OR: 1.37, p<0.05, 95% CI: 1.06-1.78) than those without NPs. Members who rated PCPs highly were also 24 percentage-points more likely to give the MA plan a high rating (OR: 6.58, p<0.01, 95% CI: 5.64-7.35) than members who did not. Conclusion:These associative relationships support an intervention where the MA plan has started placing NPs in PCP practices. Follow-up analyses will help ascertain whether embedding NPs had a causal impact on improving patient satisfaction.

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“…It utilizes principles of co-management, in this instance by registered nurses and PCPs, that have been demonstrated to be effective in improving the quality of care and the clinical outcomes of chronic conditions. 7, 26, 27, 28 STRIDE also partners with community-based fall prevention programs that have been found to reduce falls. Moreover, the intervention actively engages patients in their care through motivational interviewing and attention to risk factors that are their initial and subsequent highest priorities.…”

Section: Discussionmentioning

confidence: 99%

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management

Reuben

Gazarian

Alexander

et al. 2017

J American Geriatrics Society

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In response to the epidemic of falls and serious falls-related injuries among older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention and an enhanced usual care intervention. The STRIDE multifactorial intervention consists of 5 major components delivered by registered nurses in the role of Falls Care Managers (FCM), who co-manage fall risk in partnership with patients and their primary care providers (PCP). The components include: 1) standardized assessment of 8 modifiable risk factors (medications, postural hypotension, feet and footwear, vision, vitamin D, osteoporosis, home safety, and strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; 2) explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; 3) co-creation of individualized Falls Care Plans that are reviewed, modified, and approved by patients’ PCPs; 4) implementation of the Falls Care Plan; and 5) ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the Falls Care Plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress with results expected in late 2019.

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Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions

Cited by 56 publications

References 20 publications

Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care

Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care

Nurse Practitioners in Physician Practices: Implications for Member Satisfaction

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management

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