Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Research article

The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study

Authors: Mieke Van Der Biezen, Eddy Adang, Regi Van Der Burgt, Michel Wensing, Miranda Laurant

Published in: BMC Primary Care | Issue 1/2016

Login to get access

Abstract

Background

The pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a lack of knowledge about the impact during out-of-hours. The current study aims to provide an insight into the impact of substitution on resource use, production and direct health-care costs during out-of-hours.

Methods

At a general practitioner cooperative (GPC) in the south-east of the Netherlands, experimental teams with four GPs and one NP were compared with control teams with five GPs. In a secondary analysis, GP care versus NP care was also examined. During a 15-month period all patients visiting the GPC on weekend days were included. The primary outcome was resource use including X-rays, drug prescriptions and referrals to the Emergency Department (ED). We used logistic regression to adjust for potential confounders. Secondary outcomes were production per hour and direct health-care costs using a cost-minimization analysis.

Results

We analysed 6,040 patients in the experimental team (NPs: 987, GPs: 5,053) and 6,052 patients in the control team. There were no significant differences in outcomes between the teams. In the secondary analysis, in the experimental team NP care was associated with fewer drug prescriptions (NPs 37.1 %, GPs 43 %, p < .001) and fewer referrals to the ED (NPs 5.1 %, GPs 11.3 %, p = .001) than GP care. The mean production per hour was 3.0 consultations for GPs and 2.4 consultations for NPs (p < .001). The cost of a consultation with an NP was €3.34 less than a consultation with a GP (p = .02).

Conclusions

These results indicated no overall differences between the teams. Nonetheless, a comparison of type of provider showed that NP care resulted in lower resource use and cost savings than GP care.
To find the optimal balance between GPs and NPs in out-of-hours primary care, more research is needed on the impact of increasing the ratio of NPs in a team with GPs on resource use and health-care costs.

Trial registration

ClinicalTrials.gov ID NCT01388374.
Literature
1.
2.
Huibers LA, Moth G, Bondevik GT, Kersnik J, Huber CA, Christensen MB, Leutgeb R, Casado AM, Remmen R, Wensing M. Diagnostic scope in out-of-hours primary care services in eight European countries: an observational study. BMC Fam Pract. 2011; doi:10.​1186/​1471-2296-12-30
3.
4.
5.
Laurant M, Harmsen M, Wollersheim H, Grol R, Faber M, Sibbald B. The impact of nonphysician clinicians: do they improve the quality and cost-effectiveness of health care services? Med Care Res Rev. 2009; doi:10.​1177/​1077558709346277​.
6.
Martinez-Gonzalez NA, Djalali S, Tandjung R, Huber-Geismann F, Markun S, Wensing M, Rosemann T. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC Health Serv Res. 2014; doi:10.​1186/​1472-6963-14-214.
7.
Bruijn‐Geraets D, Daisy P, Eijk‐Hustings V, Yvonne J, Vrijhoef HJ. Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol. J Adv Nurs. 2014;70(11):2673–82.CrossRefPubMedPubMedCentral
8.
Vrijhoef HJ. Nurse Practitioners. In: Cockerham WC, Dingwall R, Quah SR, editors. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. 1st ed. Oxford: Wiley; 2014.
9.
Everett CM, Schumacher JR, Wright A, Smith MA. Physician assistants and nurse practitioners as a usual source of care. J Rural Health. 2009;25(4):407–14.CrossRefPubMedPubMedCentral
10.
Martinez-Gonzalez NA, Rosemann T, Djalali S, Huber-Geismann F, Tandjung R. Task-shifting from physicians to nurses in primary care and its impact on resource utilization: a systematic review and meta-analysis of randomized controlled trials. Med Care Res Rev. 2015; doi:10.​1177/​1077558715586297​
11.
12.
Martin-Misener R, Harbman P, Donald F, Reid K, Kilpatrick K, Carter N, Bryant-Lukosius D, Kaasalainen S, Marshall DA, Charbonneau-Smith R et al. Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review. BMJ Open. 2015;doi:10.​1136/​bmjopen-2014-007167.
13.
Martinez-Gonzalez NA, Tandjung R, Djalali S, Huber-Geismann F, Markun S, Rosemann T. Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis. PLoS One. 2014; doi:10.​1371/​journal.​pone.​0089181
14.
Swan M, Ferguson S, Chang A, Larson E, Smaldone A. Quality of primary care by advanced practice nurses: a systematic review. Int J Qual Health Care. 2015;doi:10.​1093/​intqhc/​mzv054.
15.
Huibers L, Giesen P, Wensing M, Grol R. Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009; doi:10.​1186/​1472-6963-9-105
16.
Wijers N, Schoonhoven L, Giesen P, Vrijhoef H, van der Burgt R, Mintjes J, Wensing M, Laurant M. The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol. BMC Fam Pract. 2012;doi:10.​1186/​1471-2296-13-75.
17.
Giesen P, Braspenning J. Out-of-hours GP care compared with office GP care: common complaints with an urgent character. Huisarts Wet. 2004;47(4):177.CrossRef
18.
van der Biezen M, Schoonhoven L, Wijers N, van der Burgt R, Wensing M, Laurant M. Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study. J Adv Nurs. 2016; doi:10.​1111/​jan.​12954
19.
De Bruijn-Geraets DP, Van Eijk-Hustings YJ, Vrijhoef HJ. Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol. J Adv Nurs. 2014; doi:10.​1111/​jan.​12396
20.
21.
Freund T, Everett C, Griffiths P, Hudon C, Naccarella L, Laurant M. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world? Int J Nurs Stud. 2015; doi:.10.​1016/​j.​ijnurstu.​2014.​11.​014
22.
Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. Vol. 3. Revised edition. Oxford: Oxford University Press; 2005.
23.
Hakkaaer van Roijen L, Tan S, Bouwmans CAM. Handleiding voor Kostenonderzoek. In: Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Rotterdam: Health care Insurance Council; 2010.
24.
Iglehart JK. Expanding the role of advanced nurse practitioners—risks and rewards. N Engl J Med. 2013;368(20):1935–41.CrossRefPubMed
25.
Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ. 2000;320(7241):1048–53.CrossRefPubMedPubMedCentral
26.
Curtis L, Netten A. The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix. J Nurs Manag. 2007; doi:10.​1111/​j.​1365-2834.​2007.​00668.​x
27.
Parker R, Forrest L, Desborough J, McRae I, Boyland T. Independent evaluation of the nurse-led ACT Health Walk-in Centre. Acton: The Australian National University; 2011.
28.
Pirret AM, Neville SJ, La Grow SJ. Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study. Int J Nurs Stud. 2015; doi:10.​1016/​j.​ijnurstu.​2014.​08.​009
29.
30.
31.
32.
Weiss MC, Deave T, Peters TJ, Salisbury C. Perceptions of patient expectation for an antibiotic: a comparison of walk-in centre nurses and GPs. Fam Pract. 2004;doi:10.​1093/​fampra/​cmh504.
33.
34.
Hollinghurst S, Horrocks S, Anderson E, Salisbury C. Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials. Br J Gen Pract. 2006;56(528):530–5.PubMedPubMedCentral
35.
LHV/VHN. CAO Huisartsenzorg. 1 April 2011 – 31 December 2012. Utrecht: Landelijke Huisartsen Vereniging & Vereniging Huisartsenposten Nederland; 2011.
36.
Dierick-van Daele ATM, Steuten LMG, Metsemakers JFM, Derckx EWCC, Spreeuwenberg C, Vrijhoef HJM. Economic evaluation of nurse practitioners versus GPs in treating common conditions. Br J Gen Pract. 2010; doi: 10.​3399/​bjgp10X482077
37.
McClellan CM, Cramp F, Powell J, Benger JR. A randomised trial comparing the cost effectiveness of different emergency department healthcare professionals in soft tissue injury management. BMJ Open. 2013;doi:10.​1136/​bmjopen-2012-001116.
38.
Metadata
Title
The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study
Authors
Mieke Van Der Biezen
Eddy Adang
Regi Van Der Burgt
Michel Wensing
Miranda Laurant
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0528-6

Other articles of this Issue 1/2016

BMC Primary Care 1/2016 Go to the issue

Research article

The health of Saudi youths: current challenges and future opportunities

Research article

Treatment intentions of general practitioners regarding hypertension in the oldest old: a vignette study

Research article

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

Research article

Patients’ views of adverse events in primary and ambulatory care: a systematic review to assess methods and the content of what patients consider to be adverse events

Research article

More primary care patients regret health decisions if they experienced decisional conflict in the consultation: a secondary analysis of a multicenter descriptive study

Research article

Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006