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Duderstadt, K. (2008). Medical Home: Nurse practitioners' role in health care delivery to vulnerable populations. Journal of Pediatric Health Care, 22(6):390-393.
Nurse practitioners (NPs) have a long history of providing high-quality health care to vulnerable populations in the United States, particularly populations who participate in public insurance programs including Medicare and Medicaid. Yet, the expanded Medical Home demonstration projects initiated recently by the Center for Medicare and Medicaid Services (CMS) and taken up by Congress did not include NPs. Although Congress did not intentionally seek to exclude NPs originally in the legislation, NP organizations advocating for participation in the medical home demonstration projects encountered roadblocks by CMS because the legislation did not contain NP-inclusive language.
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Horrocks, S., Anderson, E. & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324: 819-823
Objective:
To determine whether nurse practitioners can provide care at first
point of contact equivalent to doctors in a primary care
setting.
Design: Systematic review of randomised controlled trials and
prospective observational studies.
Data sources: Cochrane controlled trials register, specialist
register of trials maintained by Cochrane Effective Practice and
Organisation of Care Group, Medline, Embase, CINAHL, science citation
index, database of abstracts of reviews of effectiveness, national
research register, hand searches, and published bibliographies.
Included studies: Randomised controlled trials and prospective
observational studies comparing nurse practitioners and doctors
providing care at first point of contact for patients with undifferentiated
health problems in a primary care setting and providing data on
one or more of the following outcomes: patient satisfaction, health
status, costs, and process of care.
Results: 11 trials and 23 observational studies met all the
inclusion criteria. Patients were more satisfied with care by a nurse
practitioner (standardised mean difference 0.27, 95% confidence
interval 0.07 to 0.47). No differences in health status were found.
Nurse practitioners had longer consultations (weighted mean
difference 3.67 minutes, 2.05 to 5.29) and made more investigations
(odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were
found in prescriptions, return consultations, or referrals. Quality
of care was in some ways better for nurse practitioner consultations.
Conclusion: Increasing availability of nurse practitioners in
primary care is likely to lead to high levels of patient satisfaction
and high quality care.
Klein, T. (2005). Scope of practice and the nurse practitioner: Regulation, competency,
expansion, and evolution. Topics in Advanced Practice Nursing eJournal, 7(3)
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Bodenheimer, T., Chen, E. & Bennett, H. D. (2009). Confronting the growing burden of
chronic disease: Can the U. S. health care workforce do the job? Health Affairs, 28(1); 64-74
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Lugo, N., R., O’Gradey, E. T., Hodnicki, D. R. & Hanson, C. M. (2007). Ranking state NP regulation: Practice environment and consumer healthcare choice. The American Journal for Nurse Practitioners, 11 (4): 8-24
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Phillips, R. L., Harper, D. C., Wakefield, M., Green, L. A. & Fryer, G. E. (2002). Can nurse practitioners and physicians beat parochialism into plowshares? Health Affairs, 21 (5), 133-142
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