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Nurse practitioners may lower health care costs, improve patient outcomes

Patient outcomes were equivalent or better when seeing nurse practitioners in place of general practitioners within specialized ambulatory primary care settings, according to recently published data.

To assess the cost-effectiveness of nurse practitioners (NP) in primary and specialized ambulatory care, researchers conducted a systematic review of findings from 11 previously published randomized controlled trials conducted in the United States, the United Kingdom or the Netherlands. Evaluated roles of NPs included both alternative provider roles, where NPs provide similar services as physicians, and complementary roles, where NPs provide additional services that complement or extend existing services.

Findings from four trials showed care provided by NPs as alternative providers in ambulatory primary care settings resulted in patient outcomes that were at least equivalent to that provided by general practitioners. Alternative-role NPs were associated with longer consultation times, higher patient satisfaction and lower mean health services cost per consultation.

Two trials found that patient outcomes from alternative-role NPs roles in specialized ambulatory settings were equivalent to those of general practitioners in all but three outcomes.

Complementary-role NPs along with usual care in specialized ambulatory settings were associated with 16 superior patient/provder outcomes in five trials, compared with just usual care. Another 16 patient/provider outcomes were found to be equivalent between complementary-role NPs plus usual care and usual care alone.

The researchers noted that only one study compared costs and outcomes jointly among NPs in ambulatory primary care settings, making the evidence toward its cost effectiveness promising, but limited.

“As the grim consequences of chronic disease and social inequities continue to be revealed, the need for evidence of the cost-effectiveness of nurse practitioners in alternative and complementary roles in ambulatory care has never been greater. Future studies should include a health economist who can guide high quality economic analyses that evaluate quality of life and long-term outcomes such as the prevention of morbidity and mortality,” the researchers concluded. – by Casey Hower

Disclosures: Martin-Misener reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.