Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review
Abstract
Aims: To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long‐term care facilities and primary healthcare for the ageing population (primary aim) and to describe what influences the implementation (secondary aim). Background: Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians. Design: A systematic literature review. Data sources: PubMed, EMBASE, CINAHL, Psyc INFO, CENTRAL, Web of Science; searched January 1995–August 2015. Review methods: Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary. Results: Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level. Conclusion: Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions.
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Increased involvement of non-physicians such as Registered Nurses and Nurse Practitioners has long been recognized as an effective way to enhance access to primary care services.
“Increased involvement of non-physicians such as Registered Nurses (RNs) and Nurse Practitioners (NPs) has long been recognized as an effective way to enhance access to primary care services.6-12”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [8]
Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.
“Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.8,11,18-26”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [8]
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Adaptive physical human-robot interaction (PHRI) with a robotic nursing assistant.
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Evaluating the cost of NP-led vs. GP-led primary care in British Columbia
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Examining the Contribution of Nurse Practitioners to Geriatric and Palliative Care in Israel
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- Authors
- Lovink, M. H., Persoon, A., Koopmans, R. T. C. M., Van Vught, A. J. A. H., Schoonhoven, L., & Laurant, M. G. H.
- Affiliations
- Radboud University Medical Center (NL)
- HAN University of Applied Sciences Nijmegen The Netherlands
- HAN University of Applied Sciences (NL)
- Corresponding author
- Lovink, Marleen H.
- ORCID
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 2017-05-02
- Volume
- 73
- Issue
- 9
- Pages
- 2084-2102
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W2597348242
- Cited by
- 83
- References
- 56
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 10 · 2022: 11 · 2021: 11 · 2020: 13 · 2019: 12 · 2018: 5 · 2017: 1
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Ministry of Health, Welfare and Sport of the Netherlands (321580)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- nurse practitioners, physician assistants, population aging, long-term care, primary care, implementation factors, patient outcomes, process of care, resource utilization (health care), health care costs, physician workload
- MeSH terms
- Aged, Aged, 80 and over, Female, Geriatric Nursing, Humans, Long-Term Care, Male, Middle Aged, Nurse Practitioners, Physician Assistants, Primary Health Care, Quality of Health Care
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