COMMENTARY

Is Nurse Practitioner Care Cost-Effective?

Tom G. Bartol, NP

Disclosures

November 23, 2015

Cost-Effectiveness of Nurse Practitioners in Primary and Specialised Ambulatory Care: Systematic Review

Martin-Misener R, Harbman P, Donald F, et al
BMJ Open. 2015;5:e007167.

Measuring Outcomes of Nurse Practitioner Care

The primary outcomes of this systematic literature review were objective measures of health system utilization, including use of services (eg, length of visit, referrals, emergency department visits, hospitalizations), costs of healthcare (eg, personnel costs, medications, family costs) and health resource use (eg, diagnostic tests) of nurse practitioners (NPs) delivering primary and specialized care in the ambulatory setting. Nearly 4400 articles were identified from 1980 to 2013, with 11 of these meeting all of the criteria to be reviewed. Seven studies came from the United States, and two each from the United Kingdom and The Netherlands.

Two roles of NPs were reviewed: alternative roles and complementary roles. Alternative roles were those in which NPs provide similar services to those for whom they are "substituting" (eg, physicians). In complementary roles, NPs provide services that are "intended to complement existing services."

This review comprised 11 studies. Data were analyzed for alternative-role NPs in primary care (four studies), alternative-role NPs in specialized care (two studies) and complementary-role NPs in ambulatory specialized care (five studies). None of the studies evaluating the complementary role in primary care met the inclusion criteria. Only seven of the 11 trials measured costs, and only four of these seven studies measured both costs and outcomes.

Two high-quality studies of NPs in primary care alternative roles showed an average reduction of €6.41 per consultation, compared with costs for general practitioners. One study of NPs in the specialized complementary role showed a lower annual cost per patient of €143, although the quality of this study was assessed as low.

Martin-Misener and colleagues concluded from this study that NPs in "alternative" roles in ambulatory care have equivalent or better patient outcomes and are potentially cost-saving.

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