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

Abstract

Aim To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). Materials and methods A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. Results Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. Discussion Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. Conclusion This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO registration number CRD42020198182.

A global perspective of advanced practice nursing research: A review of systematic reviews

“…In essence, the review of systematic reviews describes the literature related to advanced practice nursing globally to identify key research gaps. The methods used in an umbrella review of indicators sensitive to primary healthcare NP practice formed the basis for the current review [ 9 , 17 ]. The descriptive table, critical appraisal and outcomes table are presented in the appendices given the large size of these tables.…”

“…The full preliminary search strategy developed for the PubMed database was subsequently adapted to each electronic database (See S2 Appendix ). We adapted strategies reviewed by an academic librarian that have been used successfully in previous reviews [ 9 , 25 ]. In addition, hand searches of reference lists of all relevant reviews were conducted to identify additional studies.…”

“…However, an understanding of the impact of these roles has been uneven across the globe because of inconsistent definitions of roles and titles, and a lack of role clarity. A recent umbrella review of primary healthcare NPs [ 9 ] documented that an average of three countries per review were found across the 44 systematic reviews. Although there are systematic reviews of APNs and CNSs in other clinical settings (e.g., Allsop et al, 2021; Audet et al, 2021; Kerr et al 2021) [ 6 , 7 , 10 ], no synthesis of this body of evidence is available using recognized advanced practice role definitions, making it difficult to compare advanced practice nursing roles internationally.…”

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

“…In addition, a recent review of systematic reviews of indicators sensitive to the practice of PHCNPs (n = 44 reviews), identified few systematic reviews focused on understanding how PHCNPs influence patient outcomes in home care services. 5…”

“…29 There is little literature on the implementation of PHCNPs in home care. 5 Home care teams that include PHCNPs demonstrate greater effectiveness in reducing service utilization and achieve comparable or improved outcomes in prevention and screening compared to teams without PHCNPs. 24,30 Chavez et al 24 showed that home care provided by PHCNPs improves physical function and reduces falls and hospital admissions, thereby helping to prolong patients' independence at home and improve their quality of life.…”