Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review.

J. W. B. Peters,G. T. Van den Brink,M. G. H. Laurant,A. J. Van Vught,R. M. A. Van Erp,A. L. Van Doorn

doi:10.5334/ijic.5485

Abstract

Introduction:Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility. The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners.Methods:Scientific databases and reference list were searched. Hits were screened on title/abstract and full text. Studies published between 1990–2018 with any study design were included. Risk of bias assessment was performed using QualSyst tool.Results:Search resulted in 5.848 hits, 15 studies were included. Studies investigated nurse practitioners only. Primary care plus was at least equally effective as hospital care (patient-related outcomes). The number of admission/referral rates was significantly reduced in favor of primary care plus. Barriers to implement primary care plus included obtaining equipment, structural funding, direct access to patient-data. Facilitators included multidisciplinary collaboration, medical specialist support, protocols.Conclusions and Discussion:Quality of care within primary care plus delivered by nurse practitioners appears to be guaranteed, at patient-level and professional-level, with better access to healthcare and fewer referrals to hospital. Most studies were of restricted methodological quality. Findings should be interpreted with caution.

Highlights

Shifting specialist care from the hospital to primary care/community care is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility
Studies had to investigate primary care plus which we defined as ‘specialist care which is usually provided by a medical specialist, physician assistant or nurse practitioner in a hospital, but which is provided in primary care setting or community care’, face-to-face, by a physician assistant or nurse practitioner with specific expertise in this patient population
This systematic review shows that primary care plus, an elaboration of integrated care models, provided by a nurse practitioner is still in its infancy, but seems a potential opportunity for well-defined patient populations

Summary

Introduction

Shifting specialist care from the hospital to primary care/community care ( called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility. The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners. The proportion of people of ≤65 years is expected to increase from 14% (2010) to 25% (2050) in the European region [1]. Patients with multimorbidity require specialist health care, which is usually provided in a hospital or a specialized clinic. One option is integrating specialist care from the hospital setting to the primary care setting or community care setting; in other words, care provided at patients’ home or close to patients’ home

Methods

Results

Discussion

Conclusion