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Nurse practitioners substituting for general practitioners: randomized controlled trial
Abstract
Title. Nurse practitioners substituting for general practitioners: randomized controlled trial. Aim. This paper is a report of a study conducted to evaluate process and outcomes of care provided to patients with common complaints by general practitioners or specially trained nurse practitioners as first point of contact. Background. Studies in the United States of America and Great Britain show that substituting nurse practitioners for general practitioners results in higher patient satisfaction and higher quality of care. As the American and British healthcare system and settings differ from that in the Netherlands, a Dutch trial was conducted. Methods. A total of 1501 patients in 15 general practices were randomized to consultation by a general practitioner or a nurse practitioner. Data were collected over a 6‐month period in 2006 by means of questionnaires, extracting medical records from practice computer systems and recording the length of consultations. Findings. In both groups, the patients highly appreciated the quality of care. No statistically significant differences were found in health status, medical resource consumption and compliance of practical guidelines in primary care in the Netherlands. Patients in the NP intervention group were more often invited to re‐attend, had more follow‐up consultations and their consultations took statistically significantly longer. Conclusion. Nurse practitioners and general practitioners provide comparable care. Our findings support an increased involvement of specially trained nurse practitioners in the Dutch primary care and contribute to knowledge of the effectiveness of care provision by nurse practitioners from a national and international perspective.
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“Measurable clinical outcomes are systematically found to be equivalent11,18,19,23,27-32 to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.11,19,21,26,27,29,30,33,34”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [28]
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Wijers, N., Schoonhoven, L., Giesen, P. H. J., Vrijhoef, H. J., van der Burgt, R., Mintjes, J. A. J., Wensing, M., & Laurant, M. G. H. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-75 · Cited by 13
“The NPs acted independently in about 90% of the consultations and the quality of care they provided was comparable to care provided by the GP [15].”
BackgroundSelf-citationBezze, E. N., Morniroli, D., Farneti, M., Sannino, P., Marinello, R., Bettinelli, M. E., Santini, G., Plevani, L., Marchisio, P., Mosca, F., et al. (2020) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2020.09.007 · Cited by 13
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“Early reviews, mainly based on British studies (Laurant et al., 2005; Dierick-vanDaele et al., 2008), found no significant differences in costs between nurse practitioner consultations and GP consultations.”
BackgroundResultInfluentialHolistic Nurse Practitioner Care Including Promotion of Shared Decision-Making
Kinchen, E. V. (2021) · Journal of Holistic Nursing · doi:10.1177/08980101211062704 · Cited by 12
“…(NPs) have provided safe, highquality, and cost-effective care for over 50 years (Avorn et al., 1991; Congressional Budget Office, 1979; Dierick-van Daele et al., 2009; Durie et al., 2000; Horrocks et al., 2002; Litaker et al., 2003; Miranda et al., 2008; Newhouse et al., 2011; Office…”
BackgroundInnovation in Cervical Cancer Prevention and Control in Mexico
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Covelli, A. F., & Salsberg, E. S. (2019) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000226 · Cited by 12
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“Also, in the Netherlands PN-led care proved to be comparable to general practitioner-led care both in general [8] and concerning smoking cessation counseling specifically [9], illustrating the potential of PN-led care to be cost saving.”
BackgroundResultAcorn, M. (2015) · International Journal of Nursing & Clinical Practices · doi:10.15344/2394-4978/2015/126 · Cited by 12
Fridlund, B., Jonsson, A., Andersson, E. K., Bala, S., Dahlman, G.-B., Forsberg, A., Glasdam, S., Hommel, A., Kristensson, A., Lindberg, C., et al. (2014) · Open Journal of Nursing · doi:10.4236/ojn.2014.43023 · Cited by 12
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The Effect of Working Conditions on Patient Care: A Systematic Review
Kapinos, K. A., Fitzgerald, P., Greer, N. L., Rutks, I. R., & Wilt, T. J. (2012) · Cited by 11
Attitudes of Dental Hygienists towards Independent Practice and Professional Autonomy.
Catlett, A. V. (2016) · PubMed · Cited by 10
Is it economically viable to employ the nurse practitioner in general practice?
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“Angelique TM Dierick-van Daele, Lotte MG Steuten, Arla Romeijn, Emmy WCC Derckx and Hubertus JM Vrijhoef Aims.”
BackgroundResultInfluentialSelf-citationKlemenc–Ketiš, Z., & Poplas‐Susič, A. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.14002 · Cited by 8
Healthcare resource availability and cardiovascular health in the USA
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“Several studies have suggested that PAs and NPs provide a similar quality of services and may contribute to cost-containment,(24) particularly in rural areas.(25) 26 Community health centres, such as Rural Health Centres (RHC) and Federally Qualified Health Centres (FQHC) funded by the Health Research and Services Adm…”
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A policy analysis of nurse practitioner scope of practice in Massachusetts
Cuccovia, B. A., Heelan‐Fancher, L., & Aronowitz, T. B. (2021) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000657 · Cited by 7
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Zijlstra, D. N., Muris, J. W. M., Bolman, C. A. W., Elling, J. M., Knapen, V., & de Vries, H. (2021) · Primary Health Care Research & Development · doi:10.1017/s1463423621000244 · Cited by 8
“Up till 10 years ago, smoking cessation support was predominantly provided by the GP. Nowadays, in most Dutch practices, smoking patients are referred to a PN (Dierick-van Daele et al., 2009).”
Background
Metadata
- Authors
- Dierick‐van Daele, A. T. M., Metsemakers, J. F. M., Derckx, E. W. C. C., Spreeuwenberg, C., & Vrijhoef, H. J. M.
- Affiliations
- Maastricht University (NL)
- Maastricht University Medical Centre (NL)
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 2009-01-15
- Volume
- 65
- Issue
- 2
- Pages
- 391-401
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W2129361092
- Cited by
- 170
- References
- 27
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 9 · 2023: 2 · 2022: 3 · 2021: 14 · 2020: 6 · 2019: 14 · 2018: 10 · 2017: 9 · 2016: 13 · 2015: 21 · 2014: 17 · 2013: 13 · 2012: 7
- FWCI
- 17.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- nurse practitioners, general practitioners, primary care, first point of contact, common complaints, quality of care, patient satisfaction, consultation time, follow-up visits, guideline adherence, Dutch primary care
- MeSH terms
- Family Practice, Humans, Netherlands, Nurse Practitioners, Quality of Health Care, Surveys and Questionnaires, Reproducibility of Results, Patient Satisfaction, Outcome Assessment, Health Care, Personnel Delegation
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