Advance practice nurse outcomes 1990–2008: A systematic review

University of Maryland School of Nursing, Baltimore, MD, USA.
Nursing economic$ (Impact Factor: 0.8). 09/2011; 29(5):230-50; quiz 251.
Source: PubMed

ABSTRACT Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.

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Available from: Robin Newhouse, Dec 30, 2013
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    • "NPs improved resource utilization and access to care [14, 18–20], increased primary care services in the community [7], and reduced costs [15]. Over the past 30 years, a number of literature reviews and systematic reviews have summarized the findings of studies evaluating NPs [21–25]. The reviews have consistently shown no difference in the health outcomes of patients receiving NP care when compared to patients receiving physician care, but often both quality of care and patient satisfaction are higher with NP care. "
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    ABSTRACT: Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (), NP-transition (), NP-inpatient (), CNS-outpatient (), CNS-transition (), and CNS-inpatient (). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
    09/2014; DOI:10.1155/2014/896587
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    • "In the descriptive or intervention research we identified, only 15 studies during a 21 year period, APRN/PAs are involved in recommending cancer screening and prevention. The limited research is somewhat surprising, because a team approach, including physicians and APRN/PAs, has long been recommended for improving healthcare [18-21,40]. After receiving the appropriate training, APRN/PAs expect to provide or recommend Pap tests, mammograms and FOBT, while studies only reported on physicians working concurrently with APRN/PAs to screen for cervical cancer [29] and colorectal cancer [28]. "
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    ABSTRACT: For more than two decades, integration of team-based approaches in primary care, including physicians, advanced practice registered nurses and physician assistants (APRN/PA), have been recommended for improving healthcare delivery, yet little is known about their roles in cancer screening and prevention. This study aims to review the current literature on the participation and roles of APRN/PAs in providing cancer screening and prevention recommendations in primary care settings in the United States. We searched MEDLINE and CINAHL to identify studies published in 1990-2011 reporting on cervical, breast, and colorectal cancer screening and smoking cessation, diet, and physical activity recommendations by APRN/PAs in the United States. A total of 15 studies met all of our eligibility criteria. Key study, provider, and patient characteristics were abstracted as were findings about APRN/PA recommendations for screening and prevention. Most studies were cross-sectional, showed results from within a single city or state, had relatively small sample sizes, reported non-standardized outcome measures. Few studies reported any patient characteristics. APRN/PAs are involved in recommending cancer screening and prevention, although we found variation across screening tests and health behavior recommendations. Additional research on the cancer prevention and screening practices of APRN/PAs in primary care settings using standardized outcome measures in relation to evidence-based guidelines may help strengthen primary care delivery in the United States.
    BMC Health Services Research 02/2014; 14(1):68. DOI:10.1186/1472-6963-14-68 · 1.71 Impact Factor
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    • "This study noted better BP outcomes with nurse-led interventions than doctorled care (Clark et al 2011). Another recent systematic review reported equivalent BP control and glucose control, better lipid control, equivalent levels of patient satis faction and selfreported perceived levels of health between APNs and physicians (Newhouse et al 2011). In New Zealand, nurse prescribers were found to provide safe, effective and clinically appropriate medication management for diabetic patients, with overall improvement of long-term blood sugar controls without adverse events or hospitalisations (Wilkinson et al 2012). "
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    ABSTRACT: The massive scarcity of physicians in India, mainly in rural areas, prompted the Union Ministry of Health and Family Welfare to propose a three-and-a-half year Bachelor of Rural Health and Care degree designed exclusively to serve rural populations. The fierce opposition by powerful medical lobbies forced the proposal to fade away. This paper emphasises the importance of "task shifting" and "non-physician prescribing" in the global context and argues that non-physician healthcare providers would not only increase availability and accessibility to rural healthcare, but also provide an empowered second line of authority, adding to the checks and balances to the exploitative prestige-based hierarchy that pervades this knowledge-intensive service. T he world is facing severe shortage of healthcare profes-sionals on the face of the ever-increasing burden of non-communicable chronic morbidities. The World Health Organisation (WHO) estimates that 57 countries are experien-cing alarmingly low levels of trained health personnel. 1 While a few Asian countries have the required doctor-patient ratio per 1,000 (Japan 2.1, Korea 2, Singapore 1.8 and China 1.4), India has only 0.69 doctors/1,000. 2 WHO estimates that India cannot achieve the recommended target of "one doctor per 1,000 people" till 2028 (Sinha 2012a). India has two healthcare professionals per 1,000 people against the WHO's recommendation of 2.8/1,000. The fi gure drops to 1.4/1,000 on removing census errors from self-reporting of false qualifi cations. Lancet suggests that the Indian health force, if adjusted for qualifi cation gaps, may be only a quarter of WHO targets (Rao et al 2011). While India is short of six lakh doctors, 10 lakh nurses, and two lakh dental surgeons, 40,000 Indian doctors are serving 50% of the British population, and around 50,000 Indian doc-tors are working in the United States (US). About 20% and 10% doctors in Australia and Canada, respectively have received their MBBS degree from India. Reports suggest that 1,157 Indian doctors migrated abroad between April 2010 and March 2011 (Duttagupta 2012; Sinha 2012b). Mass migrations appear to be a problem shared by developing nations as a whole; for instance, WHO reports that 34% of Zimbabwean nurses and 29% of Ghana's physicians are working abroad (Hooper 2008). More importantly, rural India, with 70% of the population, has only 0.39 doctors/1,000 people against 1.33 for urban. Of the available 6,77,000 doctors, 70% work in urban health-settings (Rao et al 2011). This uneven rural-urban distribution is worsened by a "prestige-based hierarchy" in which physi-cians dominate and undermine the potential contributions from non-physician healthcare professionals.
    Economic and political weekly 03/2013; XLVIII(13):112-117.
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