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Nurse practitioner–physician comanagement of primary care patients

The promise of a new delivery care model to improve quality of care

Norful, Allison Andreno; Swords, Kyleen; Marichal, Mickaela; Cho, Hwayoung; Poghosyan, Lusine

doi: 10.1097/HMR.0000000000000161
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Background: The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse practitioner (NP)–physician comanagement of primary care patients has been proposed by some policy makers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP–physician comanagement in primary care.

Purpose: This is the first review to synthesize all available studies that compare the effects of NP–physician comanagement to an individual physician managing primary care.

Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed, and inclusion/exclusion criteria were applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black’s quality checklist for randomized and nonrandomized studies.

Results: Six studies were identified for synthesis. Three outcome categories emerged: (a) primary care provider adherence to recommended care guidelines, (b) empirical changes in clinical patient outcomes, and (c) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP–physician comanagement. There was variability of clinical patient outcomes with some findings favoring the comanagement model. Limited differences in patient quality of life were found. Across all studies, the NP–physician comanagementcare delivery model was determined to produce no detrimental effect on measured outcomes and, in some cases, was more beneficial in reaching practice and clinical targets.

Practice Implications: The use of NP–physician comanagement of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP–physician interactions and processes to isolate the attributes of a successful NP–physician comanagement model.

Allison Andreno Norful, MSN, MPhil, ANP-BC, RN, is PhD Candidate, Center for Health Policy, Columbia University School of Nursing, New York, New York. E-mail: aan2139@cumc.columbia.edu.

Kyleen Swords, RN, FNP-BC, is DNP Candidate, Columbia University School of Nursing, New York, New York.

Mickaela Marichal, RN, FNP-BC, is DNP Candidate, Columbia University School of Nursing, New York, New York.

Hwayoung Cho, MSN, MPhil, RN, is PhD Candidate, Columbia University School of Nursing, New York, New York.

Lusine Poghosyan, PhD, MPH, RN, FAAN, is Assistant Professor, Columbia University School of Nursing, New York, New York.

This study is funded by the National Institute of Nursing Research Comparative and Cost-Effectiveness Research Training for Nurse Scientists (T32 NR014205; PI: Stone) and the Robert Wood Johnson Foundation Nurse Faculty Scholars Program.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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