Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Biezen, Mieke van der; Schoonhoven, Lisette; Wijers, Nancy; Burgt, Regi van der; Wensing, Michel; Laurant, Miranda

doi:10.1111/jan.12954

Cited by 35 publications

(28 citation statements)

References 54 publications

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“…However, contrary to some of the evidence (Horrocks et al, 2002), ANP consultations were not longer, the median length of home visits being the same for ANPs and GPs. Unlike in the studies by Edwards et al (2009) and Van der Biezen et al (2016), no distinction was found between the ANP and the GP attending to differing grades of patient acuity or patient condition. Prescribing patterns were also very similar, although the ANPs prescribed more analgesics than the GPs.…”

Section: Discussioncontrasting

confidence: 63%

“…One of the GP team was replaced by a NP, providing acute care during daytime weekend hours, compared to the control group of GPs only. The results showed that NPs can make a valuable contribution to patient care in the OOH (Van der Biezen et al, 2016). The number of patients seen was similar between the two study groups; however, the case mix was very different between the NP and the GPs, with GPs treating more older patients and higher urgency levels.…”

Section: Liter Ature Re Vie Wmentioning

confidence: 90%

“…A quasi-experimental study was undertaken within a GP cooperative covering the OOH period in the Netherlands over 15 months (Van der Biezen et al, 2016). One of the GP team was replaced by a NP, providing acute care during daytime weekend hours, compared to the control group of GPs only.…”

Section: Liter Ature Re Vie Wmentioning

confidence: 99%

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Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England

Collins

2018

J Nurs Manag

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Aim To measure the effectiveness of advanced nurse practitioners (ANPs) against national quality requirements for out‐of‐hours (OOH) care, to compare ANP effectiveness with that of doctors working in the same service, and to evaluate the impact of ANPs on the service. Background There is little documented evidence of ANPs undertaking urgent home visits in the OOH setting. This study advances current knowledge of this aspect of the OOH service and makes recommendations for the management of the ANP urgent home visiting service. Methods Analysis of 1,539 ANP home‐visit patient electronic case notes over a 12‐month period, a focus group of eight GPs, and interviews with six ANPs. Results Advanced nurse practitioners are as effective as GPs in undertaking urgent home visits. Their documentation is more consistent and their refer‐on rate to secondary care is less than that of GP colleagues. Conclusion Advanced nurse practitioners can provide equivalent clinical outcomes to GPs when undertaking urgent home visits. Implications for Nursing Management This study adds to the body of evidence for the positive impact of ANPs on OOH service delivery and managers can be assured that they are practising at a level that makes them effective and safe to undertake this role.

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Section: Discussioncontrasting

confidence: 63%

Section: Liter Ature Re Vie Wmentioning

confidence: 90%

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Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England

Collins

2018

J Nurs Manag

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“…Positive outcomes are reported in the literature, both in daytime general practices and at GPCs, in terms of physicians’ workload, patients’ experiences, and care outcomes [21]. A study at one GPC showed that nurses can adequately deal with 77% of all consultations [22], but further studies on this subject are recommendable.…”

Section: Discussionmentioning

confidence: 99%

Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands

et al. 2017

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BackgroundIn the Netherlands, out-of-hours primary care is provided in general practitioner-cooperatives (GPCs). These are increasingly located on site and in collaboration with emergency departments of hospitals (ED). At such sites, also called emergency-care-access-points (ECAP), the GPC is generally responsible for the triage and treatment of self-referrals who used to attend the ED. To evaluate the effects and safety of this novel organisation, we studied the characteristics and the quality of care given by GPCs to self-referrals at ECAPs.MethodsRetrospective analysis (August 2011–January 2012) of 783 records of self-referred patients at three Dutch GPCs in an ECAP. This was supplemented with a retrospective analysis of patient records during a follow-up period of three-months to asses safety.ResultsPatient-characteristics: 59% was male, 46% aged between 16–45 years and 59% trauma-related. Most cases (95%) were triaged low-urgent. None received the highest urgency-category. Quality: The triage outcome was correct in 79%, underestimated in 12% and overestimated in 9%. After GP consultation 20% were referred to the ED, mostly for radio-diagnostics. Of the referrals to secondary care, 98% were according to common medical practice. Thirty percent had a follow-up contact, mostly with their own general practitioner, seldom with the ED. Complications, all non-severe, were registered in 3.2%; 0.4% were possibly preventable.ConclusionsSelf-referred patients at an ECAP are mostly trauma related, low-urgent and male patients. The majority could be treated by the GPC without subsequent referral to the ED. Care given at the GPC is reasonably efficient and safe. Triage and treatment of self-referrals by the GPC at ECAPs might offer opportunities for other countries facing problems with inappropriate emergency department visits.

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“…This gave a more detailed picture of their daily practices, and allowed for continuous monitoring. A similar method of measuring autonomy was used in a study by van der Biezen et al(33).ResultsNumber of NP consultations and share of home visitsOver the whole data collection period, the NP of Practice A had 1247 consultations. The mean number of consultations per month was 96 (SD 47.9).…”

mentioning

confidence: 99%

Nurse practitioners in Swiss family practices as potentially autonomous providers of home visits: an exploratory study

Gysin

Bischofberger

Meier

et al. 2020

Preprint

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Background Switzerland is challenged by impending shortages of general practitioners (GPs) in rural areas and decreasing number of GP home visits. In Anglo-Saxon and many other countries, nurse practitioners (NPs) have been implemented and provide high quality, patient-centred home visits autonomously. In Switzerland, the NP role is new and there are currently only a handful of ongoing pilot projects in family practices. Hence, studies are lacking and data collection is challenging as NPs are not yet registered providers who could be identified in billing or health insurance data. Our aims were to gain insights in the frequency of home visits by NPs in Swiss family practices, and to determine their autonomy during visits and consultations based on the required level of GP supervision. Methods We used consultation data from two pilot practices in rural Switzerland. In “Practice A”, the NP was in postgraduate education and data was gathered electronically between August 2017 and 2018. In “Practice B”, the NP had completed her education, and had two years of work experience as a NP when data was collected manually between April and June 2018. We used a coding system based on five levels of GP supervision to identify NP consultations and home visits, and to determine the NPs’ autonomy in each consultation. Results We analysed data from 1375 consultations. The share of home visits in all NP consultations was 17% in Practice A and 51% in Practice B. Both NPs had a higher share of autonomously conducted consultations during home visits than in the office. In Practice A, the proportion of consultations in which the NP was autonomous increased from 0% in the first month of her employment to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of her consultations. Conclusions First cases provide some evidence that after completing postgraduate education with clinical supervision by GPs, and few years of practical experience in their role, NPs could reach a relatively high degree of autonomy and might pose a potential solution to the decreasing numbers of GP home visits in Swiss primary care.

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Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Cited by 35 publications

References 54 publications

Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England

Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England

Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands

Nurse practitioners in Swiss family practices as potentially autonomous providers of home visits: an exploratory study

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