Models of NP Integration into the Workflow of Primary Care Practices: A Systematic Review

Abstract

Background Nurse practitioners (NPs) have been proposed as one solution to the U.S. primary care physician shortage, leading to a body of research on the appropriate scope of work for the new professional role of an NP within primary care practices. Yet, among studies of NP integration into patient care workflows, there is a lack of consistency in the terminology used to describe models of care. This work aims to provide more clarity around ill-defined and overlapping terms around NP integration into primary care and therefore advance the conversation around NP integration into the workflow of primary care practices. Methods A systematic review of articles on NP-physician interprofessional relationships and models of care was conducted to develop an inclusive overview of the academic literature on this topic. Results A total of 42 papers fit the inclusion criteria. The terms most frequently used to describe NP integration were collaboration, team-based approaches, and comanagement. Most papers used a combination of terms to describe a specific type of NP integration. Only 28 presented a thorough description of NP-physician interactions. Guided by theory, papers were categorized based on power structure (hierarchical vs. complementary) and processes of primary care provision (collaborative vs. siloed), leading to the identification of four distinct models of NP integration – complementary/collaborative, complementary/hierarchical, siloed/collaborative, and siloed/hierarchical. The most common categorization was complementary/collaborative. Conclusion This research highlights the lack of differentiation between terms currently used to describe NP integration into primary care and presents new labels that describe distinct models of care.