To assess patients' views on the care provided by nurse practitioners compared with that provided by general practitioners and to determine factors influencing these views.
Many countries have sought to shift aspects of primary care provision from doctors to nurses. It is unclear how patients view these skill mix changes.
Patients (n = 235) who received care from both nurse and doctor were sent a self-administered questionnaire. The main outcome measures were patient preferences, satisfaction with the nurses and doctors and factors influencing patients' preference and satisfaction.
Patients preferred the doctor for medical aspects of care, whereas for educational and routine aspects of care half of the patients preferred the nurse or had no preference for either the nurse or doctor. Patients were generally very satisfied with both nurse and doctor. Patients were significantly more satisfied with the nurse for those aspects of care related to the support provided to patients and families and to the time made available to patients. However, variations in preference and satisfaction were mostly attributable to variation in individual patient characteristics, not doctor, nurse or practice characteristics. Conclusion: Patient preference for nurse or doctor and patient satisfaction both vary with the type of care required and reflect usual work demarcations between nurses and doctors. In general, patients are very satisfied with the care they receive.
In many countries, different aspects of primary care provision have shifted from doctors to nurses. Our study suggests that these skill mix changes meet the needs of patients and that patients are very satisfied with the care they receive. However, to implement skill mix change in general practice it is important to consider usual work demarcations between nurses and doctors.
"Surprisingly, patient satisfaction was higher with general nurses (as compared to NPs or NPs with higher degree/extra courses), but the two very small studies showing this effect addressed tasks for very special conditions such as incontinence and family planning. This finding fits in with previous research which showed that patients appreciate nurses’ involvement especially in education and counselling [47,48]. "
[Show abstract][Hide abstract] ABSTRACT: Background
In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care.
We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses.
24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N <= 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies.
The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.
BMC Health Services Research 05/2014; 14(1):214. DOI:10.1186/1472-6963-14-214 · 1.71 Impact Factor
"Moreover, one study did not find any relationship between age and preference scores. This study concluded that the results for patients’ preferences are mixed and that ‘the reason for this is unclear and may relate to a number of factors’ . "
[Show abstract][Hide abstract] ABSTRACT: Previous research showed inconsistent results regarding the relationship between the age of patients and preference statements regarding GP care. This study investigates whether elderly patients have different preference scores and ranking orders concerning 58 preference statements for GP care than younger patients. Moreover, this study examines whether patient characteristics and practice location may confound the relationship between age and the categorisation of a preference score as very important.
Data of the Consumer Quality Index GP Care were used, which were collected in 32 general practices in the Netherlands. The rank order and preference score were calculated for 58 preference statements for four age groups (0--30, 31--50, 51--74, 75 years and older). Using chi-square tests and logistic regression analyses, it was investigated whether a significant relationship between age and preference score was confounded by patient characteristics and practice location.
Elderly patients did not have a significant different ranking order for the preference statements than the other three age groups (r = 0.0193; p = 0.41). However, in 53% of the statements significant differences were found in preference score between the four age groups. Elderly patients categorized significantly less preference statements as 'very important'. In most cases, the significant relationships were not confounded by gender, education, perceived health, the number of GP contacts and location of the GP practice.
The preferences of elderly patients for GP care concern the same items as younger patients. However, their preferences are less strong, which cannot be ascribed to gender, education, perceived health, the number of GP contacts and practice location.
BMC Family Practice 06/2013; 14(1):90. DOI:10.1186/1471-2296-14-90 · 1.67 Impact Factor
"The educational requirements and scope of practice of the role are shaped by the context and/or country, which constrain direct comparison of research. That said, there is some evidence in international contexts that the introduction of NPs increases service-users' satisfaction, improve health outcomes, reduce the prescription of pharmaceuticals, and decrease readmission to acute care (Brown & Grimes, 1995; Horrocks, Anderson, & Salisbury, 2002; Laurant, Hermens, Braspenning, Sibbald, & Grol, 2004; Laurant et al., 2008; Mundinger et al., 2000). Further, service users have been shown to be accepting of NPs as care providers in Australia (Parker, Forrest, Ward, McCracken, Cox, & Derrett, 2013) and North America (Agosta, 2009), while there is some evidence of the positive impact of NPs in aged care settings (Christian & Baker, 2009; Dick & Frazier, 2006). "
[Show abstract][Hide abstract] ABSTRACT: A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.
Evaluation and program planning 06/2013; 40C:55-63. DOI:10.1016/j.evalprogplan.2013.05.003 · 0.89 Impact Factor
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