A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions
Open accessAbstract
Multiple chronic conditions (MCCs) are more common and costly than any individual health condition in the United States. The growing workforce of nurse practitioners (NPs) plays an active role in providing primary care to this patient population. This study identifies the effect of NP primary care models, compared with models without NP involvement, on cost, quality, and service utilization by patients with MCCs. We conducted a literature search of six databases and performed critical appraisal. Fifteen studies met inclusion criteria (years: 2003–2021). Overall, most studies showed reduced or similar costs, equivalent or better quality, and similar or lower rates of emergency department use and hospitalization associated with NP primary care models for patients with MCCs, compared with models without NP involvement. No studies found them associated with worse outcomes. Thus, NP primary care models, compared with models without NP involvement, have similar or positive impacts on MCC patient outcomes.
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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 [23]
The Outcomes and Discussion sections report similar or improved outcomes for nurse practitioner primary care in patients with multiple chronic conditions, supporting the general point about effectiveness. But the Critical Appraisal section rates all three randomized trials as having a high risk of bias and most quasi-experimental studies as having moderate or high risk, so the paper does not support describing the evidence as many studies with strong research designs. Its findings are also specific to nurse practitioner care for patients with multiple chronic conditions, rather than nursing-intensive primary care generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe economic impact of nurse-led primary care remains less documented than its clinical quality.
“Nevertheless, the economic impact of nurse-led primary care remains less documented than its clinical quality.9,20,23,26,42-44”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [23]
The Cost of Care section reports that only four of the 15 included studies measured costs, while the Discussion identifies five studies addressing guideline-concordant care, one aspect of clinical quality. This supports the comparison within the review’s scope, but the review concerns nurse practitioner primary care for US patients with multiple chronic conditions, not nurse-led primary care generally. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMeasurable clinical outcomes are systematically found to be equivalent to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.
“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 [23]
The Outcomes section (page unavailable) reports no difference for some clinical measures, but also modest improvements in diabetes measures and blood pressure in some studies; it does not establish that measurable outcomes are systematically equivalent. The Study Characteristics section (page unavailable) reports increased patient satisfaction after one NP-involved program, without showing that satisfaction was higher than under physician-provided care. (LLM, conf=0.87)
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Cited by
Sorted by citations
Evaluating the cost of NP-led vs. GP-led primary care in British Columbia
Contandriopoulos, D., Bertoni, K., McCracken, R., Hedden, L., Lavergne, R., & Randhawa, G. K. (2024) · Healthcare Management Forum · doi:10.1177/08404704241229075 · Cited by 5 · see citing works
“16,17 18-26 Measurable clinical outcomes are systematically found to be equivalent 11,18,19,23,27-32 to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.”
Background
- Authors
- McMenamin, A., Turi, E., Schlak, A., & Poghosyan, L.
- Affiliations
- Columbia University (US)
- United States Department of Veterans Affairs (US)
- Corresponding author
- McMenamin, Amy
- Venue
- Medical Care Research and Review
- Publisher
- SAGE Publications
- Published
- 2023-07-12
- Volume
- 80
- Issue
- 6
- Pages
- 563-581
- ISSN
- 1077-5587 (ISSN-L)
- 1552-6801
- PMC
- PMC10784406
- OpenAlex
- W4384120438
- Cited by
- 88
- References
- 55
- Citations by year
- 2026: 40 · 2025: 30 · 2024: 14 · 2023: 3
- FWCI
- 4.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Medical Care Research and Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R36 HS029435)
- National Institute for Nursing Research (T32 NR014205)
- National Institute on Minority Health and Health Disparities (R01 MD011514)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- nurse practitioners, multimorbidity, primary care models, health care costs, quality of care, emergency department utilization, hospitalization, patient outcomes
- MeSH terms
- Multiple Chronic Conditions, Emergency Service, Hospital, Hospitalization, Humans, Nurse Practitioners, Primary Health Care, United States
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