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NP Care Cost Effective and On Par with Physician Care According to Research

June 10, 2008

This post is to confirm what many health care providers have already known, that care by NP’s is both economical and equivalent in quality to physician care. In just a short search of major research and journal databases, that include CINHAL, Lancet, Ovid Healthstar and MEDLine thousands of articles on the subject can be found. Anecdotal evidence be put aside for this post. The following are articles published in both nursing and medical journals that support my beginning premise.
1. Carter, A. & Chochinov, A. (2007). A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction, and wait times in the emergency department. Canadian Journal of Emergency Medicine, 9(4), 286-295. This team found that nurse practitioners reduced wait time, increased access to care, and provide the same quality care as “mid-grade” residents.
2. Wilson, I.B. et al. (2005).Quality of HIV care provided by Nurse Practitioners, Physician Assistants, and Physicians. Annals of Internal Medicine 143(10), 729-736.
The conclusion summary of the article sums up the findings well “For the measures examined, the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non–HIV experts. Nurse practitioners and PAs can provide high-quality care for persons with HIV.” FYI – this study found that NP’s and PA’s were more likely to do PAP smears in this population than both infectious disease specialists and HIV specialist MD’s.
3. Ohman-Strickland, P.A. et al. (2008). Quality Diabetes Care in Family Medicine Practices: Influence of Nurse Practitioners and Physician Assistants. Annals of Medicine, 6, 14-22.
This article found that NP’s were more likely than MD’s and PA’s to do hemoglobin A1C testing, the every three month test to measure diabetes control, cholesterol and lipid levels and tests for kidney function. This finding was regardless of the use of registries, nurse diabetes counseling or reminder systems in the offices.
4. Sears JM. Wickizer TM. Franklin GM. Cheadle AD. Berkowitz B. Nurse practitioners as attending providers for workers with uncomplicated back injuries: using administrative data to evaluate quality and process of care. This article found very little difference between NP’s and MD’s in management of back injuries based on state wide data from the state of Washington.
5. Friedemann ML. Do clinical nurse practitioners affect the working environment and the quality of care? Pflege. 10(2):86-90, 1997 Apr. This is a German article on a Swiss study about NP’s in hospital units. The large multi-center study found that NP’s on the hospital units improved care guidelines, direction, and professional feedback on the units with NP’s. Patient acuity and staffing were taken into account in this analysis.
This was just the top 5 articles. Likewise there have been publications supporting NP quality of care in JAMA in 2000. In a study of nursing home care in the journal of nursing scholarship (2000) there was absolutely no difference in work ethic between NP’s and Physicians and patient care, and in fact NP’s spent more time with the patients. Also, in a large study done by MD’s and NP’s on smoking cessation it was found that NP’s counseled more on this topic by far than physicians (NP: American Journal of Primary Health Care, 1990).

In the American Journal of Critical Care (2003) an article comparing physician residents and NP work time on tasks and pt. interactions was made. NP’s had the same time with tasks and care, but spent more time with the pt. than the residents. I could go on and on, one simple search landed over 562 such articles.
The efficacy and cost effectiveness of NP care cannot be denied. In fact, I found no research that proved the opposite. This is wonderful news for nursing, patients, and health care in general. Bring on the NP’s!


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