Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

Mundinger, Mary OʼNeil; Kane, Robert L; Lenz, Elizabeth R.; Totten, Annette M; Tsai, Wei Yann; Cleary, Paul D.; Friedewald, William T.; Siu, Albert L.; Shelanski, Michael L.

doi:10.1001/jama.283.1.59

Cited by 805 publications

(210 citation statements)

References 20 publications

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“…They work collaboratively with physicians, nurses, and other healthcare professionals to provide the best possible care for their patients. The effectiveness of APNs in a practice setting seems similar to that of physicians, and is supported by the results of patient satisfaction with their services (Mundinger, et al, 2000;Rhee & Dermyer, 1995 …”

Section: Advanced Practice Nursing Historymentioning

confidence: 78%

“…The care provided by NPs for various patient populations seems to be equivalent to the quality of care provided by medical staff (Bevis et al, 2008;Budzi et al, 2010;Guzik et al, 2009;Kleinpell et al, 2008;Mundinger, et al, 2000;Pioro et al, 2001;Sakr et al, 1999). Nurse practitioners working in emergency departments provide care for a variety of patients and have to perform numerous procedures.…”

Section: Quality Of Carementioning

confidence: 99%

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Mentoring Nurse Practitioners in a Hospital Setting

Pop¹

2017

Journal of Nursing Research

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Background: Nursing philosophy is the foundation of nurse practitioner (NP) training. However, NP practice is based on the medical care model. Thus, the necessity of mediating between these two approaches is often problematic for new NPs who are transitioning into their new roles. Mentoring has been used successfully to facilitate role transition and role understanding for nurses, NPs, and physicians. However, mentoring has been rarely studied in NPs. Purpose: The purpose of this study was to develop a theory of mentoring for new NPs in a hospital setting. Methods: Grounded theory methodology was used. The sampling approach was initially purposive and was then shifted to theoretical to ensure the collection of meaningful data. Semistructuredinterviews were recorded and transcribed into Word documents for analysis. The three-phase analysis developed by Corbin and Strauss was initiated after the second interview. Results: Sixteen participants (eight mentors and eight mentees) were interviewed between February and June 2011. The core category that emerged from the data was “defining self,” and the main categories were forming the relationship, developing the relationship, and mentoring outcomes. Conclusions: A well-designed formal mentoring program may greatly improve the transition of NPs into a new role. The theory generated by the data from these study participants provides clearly defined categories that may be operationally defined and utilized to develop evaluation tools for mentoring programs.

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Section: Advanced Practice Nursing Historymentioning

confidence: 78%

Section: Quality Of Carementioning

confidence: 99%

Mentoring Nurse Practitioners in a Hospital Setting

Pop¹

2017

Journal of Nursing Research

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“…Recent studies have demonstrated comparable care quality, whether primarily administered by APPs or by physicians 8, 22, 23. One small prospective study showed improvements in secondary prevention target goals, including statin use at follow‐up and smoking cessation, for post‐MI patients cared for by nurse practitioners versus usual care 22.…”

Section: Discussionmentioning

confidence: 99%

“…In current practice, frequently cited reasons for integrating APPs into clinical practices include resident duty hour restrictions and a need to improve continuity of care and timely patient access to care 4. In primary care practices focused on maintenance of health, evidence suggests that APPs provide quality of care comparable to that of physicians while improving upon patient satisfaction 5, 6, 7, 8, 9…”

Section: Introductionmentioning

confidence: 99%

Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction

Rymer

Chen

Thomas

et al. 2018

JAHA

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BackgroundPhysician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown.Methods and ResultsWe examined outpatient cardiology or primary care visits within 90 days post‐myocardial infarction among 29 477 Medicare‐insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all‐cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APPs versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP. Patients seen by APPs were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post‐discharge (median 6 versus 5, P<0.01 for all) than those seen by physicians only. Adherence to evidence‐based medications (adjusted odds ratio, 0.98; 95% confidence interval, 0.89–1.08) and readmission risks (adjusted hazard ratio, 1.11; 95% confidence interval, 0.99–1.26) were similar between patients seen by APPs versus physicians only. Risks of 90‐day mortality (adjusted hazard ratio, 1.18; 95% confidence interval, 0.98–1.42) and major adverse cardiovascular events (adjusted hazard ratio, 1.06; 95% confidence interval, 0.90–1.23) were also similar between patients seen by APPs versus physicians only.Conclusions APPs were likely used to provide more frequent monitoring of high‐risk post‐MI patients. Medication adherence, readmission risk, mortality, and major adverse cardiovascular events did not differ substantially between patients seen by physician‐APP teams than those seen by physicians only.

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“…The research on NP, CMN, and PA practice has demonstrated consistently safe and quality care comparable to that provided by FPs. [5][6][7][8][9][10][11][12][13][14][15][16] This has been reinforced again and again for NPs, CNMs, and PAs throughout decades of practice. However, the real issue is being able to work together for the good of patients and the health of the nation.…”

mentioning

confidence: 99%