Home-based primary care visits by nurse practitioners

Abstract

Background: With rapidly growing numbers of homebound older adults, the need for effective home-based health interventions is increasingly recognized. Advanced practice registered nurses (NPs) are one of the most common providers of home-based primary care. Limited information is available to address the scope and nature of NP-led home-based primary care and associated outcomes.Objective: To synthesize research evidence of NP visits in home-based primary care.Data Sources: Six electronic databases-PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Web of Science, and Scopus-were searched to identify peer-reviewed research articles addressing homebased primary care interventions led by NPs. Independent screening resulted in 17 relevant articles from 14 unique studies to include in the review.Conclusions: Nurse practitioners provided health assessments, education, care planning and coordination primarily by face-to-face home visits. Despite a variability in terms of study design, setting, and sample, NP-led home-based primary care was in general associated with less hospitalization and fewer emergency department visits. Evidence was mixed in relation to patient-reported outcomes such as subjective health, functional status, and symptoms. Costs and patient or caregiver satisfaction were additional outcomes addressed, but the findings were inconsistent.Implications for Practice: Recent policy changes to authorize NPs to independently assess, diagnose, and order home care services directly affect how NPs approach home-based primary care programs. Our findings support NP-led home-based primary care to decrease consequential health utilization and suggest the need for further evaluating the care models in diverse populations with more patient-reported and caregiver outcomes.

Evaluating the influence of primary healthcare nurse practitioners' interventions in home care on hospitalizations and emergency department transfers

“…Due to the inability to differentiate between hospitalizations and ED transfers in the extracted data, they were treated as a combined dependent (outcome) variable. This choice was supported by previous research that has treated these variables separately or combined 30,35 . Independent variables encompassed patient‐related variables, patient‐related events, and setting‐related variables 33,34,36 .…”

“…Hospitalizations and ED transfers were significantly reduced when PHCNP provided planned interventions. Although other countries have integrated PHCNPs into these teams, 30,35 few studies have examined the effect of this practice on hospitalization and transfer of people to the ED. Since one of the objectives of home care provision is to reduce the number of in-patient admissions and ED transfers where possible, 46,47 our results add to understanding whether the addition of PHCNPs to home care teams is an effective solution for meeting healthcare needs.…”

“…This choice was supported by previous research that has treated these variables separately or combined. 30,35 Independent variables encompassed patient-related variables, patient-related events, and settingrelated variables. 33,34,36 Patient complexity was measured by considering the number of different systems addressed (e.g., cardiovascular, renal and endocrine), the maximal simultaneous number of medications in each patient's EHR, and the demand for respite care among family caregivers.…”

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews

“…These indicators were categorized into health, cardiovascular, cancer care, diabetes, mental health, renal, respiratory, rheumatoid arthritis outcomes. Each one is detailed below: a. Clinical/Health outcomes were found in eight studies [12,35,36,41,42,47,53,57,58] and included health risk reduction, health status, self-reported perceived health, SF 36 physical composite score, physiologic measures, and clinical outcomes. Milesky et al [47] reported that NPs improved health outcomes in almost one fifth of theme occurrences.…”

“…g. Clinical/Respiratory outcomes were outlined in six reviews [27,29,33,35,36,53,60]. No significant differences were noted between the intervention and control groups for change in maximal peak flow in asthma, emergency nebulization, frequency of exacerbation, 6-month follow-up, asthma severity, asthma symptoms, absence from school or work due to asthma, forced expiratory volume at one second (FEV1), peak flow rate, airway hyperreactivity using PD/PC20 methacholine/histamine, as well as lung function at 12 h. Clinical/Rheumatoid arthritis outcomes were noted in two studies [56,59].…”