Cited by 310Nursing Roles and PracticesPrimary Care and Health OutcomesNursing education and management

The DOI matches its Crossref record; 50 of the 50 references it cites were found in a registry or an index.

Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Open access

Martínez-González, Nahara Anani, Djalali, Sima, Tandjung, Ryan, Huber-Geismann, Flore, Markun, Stefan, Wensing, Michel, Rosemann, Thomas·2014·BMC Health Services Research

DOI 10.1186/1472-6963-14-214PMC PMC4065389

Open this paper in CoChat — free account Open PDF

Abstract

Background: In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. Methods: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. Results: 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N ≤ 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. Conclusions: The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1186/1472-6963-14-214

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Figure 1 PRISMA Flow Diagram - study selection process.CC BY · PubMed Central

Figure 2 Effects of physician-nurse substitution on patient satisfaction in A) all trials and by B) subgroups. Legend. CI, confidence interval; df, degrees of freedom; N, total number of patients; SMD, standard mean differences; SD, standard deviation; Chi2, statistical test for heterogeneity; P, p-value of Chi2 (evidence of heterogeneity of intervention effects); I2, amount of heterogeneity between trials; Overall P, p-value for significance of effects of interventions; NLC, Nurse-Led Care; PLC, Physician-Led Care; NP, Nurse Practitioner; NP+, Nurse Practitioner with higher degree/courses/specialisation; RN, Registered Nurse. *All trials had ≥20% attrition in at least one arm.CC BY · PubMed Central

Figure 3 Effects of physician-nurse substitution on hospital admissions in A) all trials and by B) subgroups. Legend. CI, confidence interval; df, degrees of freedom; N, number of patients with events; Total, total number of patients per group; RR, Relative Risk; Chi2, statistical test for heterogeneity; P, p-value of Chi2 (evidence of heterogeneity of intervention effects); I2, amount of heterogeneity between trials; Overall P, p-value for significance of effects of interventions; NLC, Nurse-Led Care; PLC, Physician-Led Care; NP, Nurse Practitioner; NP+, Nurse Practitioner with higher degree/courses/specialisation; RN, Registered Nurse. *Two RCTs provided data for different follow-up episodes and were incorporated accordingly: Andryukhin et al. (2010) [46] reported data at 6 and 18 months and Mundinger et al. (2000) [22,24] reported data at 6 and 12 months.CC BY · PubMed Central

Figure 4 Effects of physician-nurse substitution on mortality in A) all trials and by B) subgroups. Legend. CI, confidence interval; df, degrees of freedom; N, number of patients with events; Total, total number of patients per group; RR, Relative Risk; Chi2, statistical test for heterogeneity; P, p-value of Chi2 (evidence of heterogeneity of intervention effects); I2, amount of heterogeneity between trials; Overall P, p-value for significance of effects of interventions; NLC, Nurse-Led Care; PLC, Physician-Led Care; NP, Nurse Practitioner; NP+, Nurse Practitioner with higher degree/courses/specialisation; RN, Registered Nurse. *Andryukhin et al. (2010) [46] reported data at 6 and 18 months and was incorporated accordingly.CC BY · PubMed Central

Figure 5 Comparison of individual trial estimates of the effect of physician-nurse substitution on Quality of Life. Legend. A pooled estimate was not possible due to the various scales used, grading scores and measurements. SMD, standard mean difference; SE, standard error; N, total number of patients per group; CI, confidence interval; NLC, Nurse-Led Care; PLC, Physician-Led Care.CC BY · PubMed Central

Figure 6 Comparison of individual trial estimates of the effect of physician-nurse substitution on cost of care. Legend. A pooled estimate was not possible due to the variety in approaches, currency and indicators used to value resources and to calculate costs. Abbreviations: EUR, Euro; GBP, pound sterling; DCC, direct costs for consultations; DPCC, direct and productivity costs for consultations; general physicians (GP); EMP, employment; EMPO, employment by others; LoC, length of consultations; TCT, total consultation time; TP, time to prescribe; FTF, face-to-face; TT, total time; SD, standard deviation; N, total number of patients per group; SMD, standard mean difference; CI, confidence interval; NLC, Nurse-Led Care; PLC, Physician-Led Care. *EUR; DPCC: GPs salary in EMP and EMPO; p = 0.65. †EUR; DCC based on resource use, follow-up, LoC /salary; p = 0.0005. ‡EUR; DCC: resource use, follow-up, LoC /salary; p = 0.0001. §EUR; all patients: DPCC: GP salary in EMP and EMPO; p = 0.0009. ║EUR; <65 years: DPCC: GP salary in EMP and EMPO; p < 0.0001. ¶GBP; return consultations, FTF time: NP = TCT - TP (GP signed); GP = TCT - TP; p = 0.11. #GBP; initial consultations, TT: NP = TCT + TP (GP signed); GP = TCT + TP; p = 0.11. **GBP; initial consultations, FTF time: NP = TCT – TP (GP signed); GP = TCT + TP; p = 0.07. ††GBP; return consultations, TT: NP = TCT – TP (GP signed); GP = TCT + TP; p = 0.16. ‡‡GBP; costs of drugs; p < 0.0001. §§GBP; mean QALYs at 48 months: SF-36 overall QoL scores; p = 0.0006. ║║EUR; DPCC: resource use, follow-up, LoC and salary; p = 0.09. ¶¶EUR; DC: resource use, follow-up, LoC and salary; p = 0.04. ##EUR; <65 years of age; DPCC: resource use, follow-up, LoC and salary; p = 0.10.CC BY · PubMed Central

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164
The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,586
Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709
Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration
Higgins, J., Green, S. R., & Higgins, J. (2008) · Cited by 5,544
Assessing the quality of controlled clinical trials
Jüni, P., Altman, D. G., & Egger, M. (2001) · BMJ · doi:10.1136/bmj.323.7303.42 · Cited by 3,309 · cited 3×
“We assessed the risk of bias of all trials without the calculation of a composite score following available guidelines [6-8].”
BackgroundMethod
The Hazards of Scoring the Quality of Clinical Trials for Meta-analysis
Jüni, P. (1999) · JAMA · doi:10.1001/jama.282.11.1054 · Cited by 1,981
Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors
Horrocks, S., Anderson, E., & Salisbury, C. (2002) · BMJ · doi:10.1136/bmj.324.7341.819 · Cited by 1,235
Substitution of doctors by nurses in primary care
Laurant, M. G. H., Reeves, D., Hermens, R., Braspenning, J., Grol, R. P. T. M., & Sibbald, B. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001271.pub2 · Cited by 961

Show all 50 references

Research works printed but not linked: 3

World Health Organization: World Health Statistics 2012: Indicator Compendium. 2012, Geneva, Switzerland: WHO
Review Manager: (RevMan) [Computer program] Version 5.2.4 for Windows edition. 2012, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, http://tech.cochrane.org/revman.
Winter C: Quality health care: patient assessment. 1981, MSc Thesis: California State University

Sorted by citations

Nurses in advanced roles in primary care
Maier, C. B., Aiken, L. H., & Busse, R. (2017) · OECD health working papers · doi:10.1787/a8756593-en · Cited by 1,031
Nurses as substitutes for doctors in primary care
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001271.pub3 · Cited by 614
The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0237-9 · Cited by 459
Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study
Maier, C. B., & Aiken, L. H. (2016) · European Journal of Public Health · doi:10.1093/eurpub/ckw098 · Cited by 403
Quality of primary care by advanced practice nurses: a systematic review
Swan, M., Ferguson, S., Chang, A., Larson, E., & Smaldone, A. M. (2015) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzv054 · Cited by 339
Care for low back pain: can health systems deliver?
Traeger, A., Buchbinder, R., Elshaug, A., Croft, P., & Maher, C. (2019) · Bulletin of the World Health Organizatino · doi:10.2471/blt.18.226050 · Cited by 243
Task shifting in primary care to tackle healthcare worker shortages: An umbrella review
Leong, S. L., Teoh, S. L., Fun, W. H., & Lee, S. W. H. (2021) · European Journal of General Practice · doi:10.1080/13814788.2021.1954616 · Cited by 228
Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis
Karimi‐Shahanjarini, A., Shakibazadeh, E., Rashidian, A., Hajimiri, K., Glenton, C., Noyes, J., Lewin, S. A., Laurant, M. G. H., & Colvin, C. J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010412.pub2 · Cited by 180
What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence
Coster, S., Watkins, M., & Norman, I. J. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.10.009 · Cited by 204
Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis
Massimi, A., Vito, C. D., Brufola, I., Corsaro, A., Marzuillo, C., Migliara, G., Rega, M. L., Ricciardi, W., Villari, P., & Damiani, G. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173617 · Cited by 148
Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential
Maier, C. B., Barnes, H., Aiken, L. H., & Busse, R. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011901 · Cited by 144
The Development and Performance of After-Hours Primary Care in the Netherlands
Smits, M., Rutten, M., Keizer, E., Wensing, M., Westert, G., & Giesen, P. H. J. (2017) · Annals of Internal Medicine · doi:10.7326/m16-2776 · Cited by 138
Self-citation
Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis
Rashidian, A., Shakibazadeh, E., Karimi‐Shahanjarini, A., Glenton, C., Noyes, J., Lewin, S. A., Colvin, C. J., & Laurant, M. G. H. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010412 · Cited by 127
Geographic variation in spatial accessibility of U.S. healthcare providers
Naylor, K. B., Tootoo, J. L., Yakusheva, O., Shipman, S. A., Bynum, J., & Davis, M. A. (2019) · PLoS ONE · doi:10.1371/journal.pone.0215016 · Cited by 124
Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care
Liu, C., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., Sales, A. E., & Wong, E. S. (2020) · Health Services Research · doi:10.1111/1475-6773.13246 · Cited by 121
Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study
Gysin, S., Sottas, B., Odermatt, M., & Essig, S. (2019) · BMC Family Practice · doi:10.1186/s12875-019-1055-z · Cited by 115
Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years
Liang, P. S., Wheat, C. L., Abhat, A., Brenner, A. T., Fagerlin, A., Hayward, R. A., Thomas, J. P., Vijan, S. S., & Inadomi, J. M. (2015) · The American Journal of Gastroenterology · doi:10.1038/ajg.2015.367 · Cited by 114
New Nurse Practitioners’ Perceptions of Preparedness for and Transition Into Practice
Hart, A. M., & Bowen, A. P. (2016) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2016.04.018 · Cited by 112
Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study
Carryer, J., & Adams, S. (2016) · Collegian Journal of the Royal College of Nursing Australia · doi:10.1016/j.colegn.2016.12.001 · Cited by 104
Nurse-led telehealth intervention effectiveness on reducing hypertension: a systematic review
Kappes, M. S., Espinoza, P., Jara, V. J., & Hall, A. (2023) · BMC Nursing · doi:10.1186/s12912-022-01170-z · Cited by 97
The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia
Maier, C. B. (2015) · Health Policy · doi:10.1016/j.healthpol.2015.09.002 · Cited by 96
International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review
Chavez, K. S., Dwyer, A. A., & Ramelet, A. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.09.010 · Cited by 102
Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians
Buerhaus, P. I., Perloff, J. N., Clarke, S. P., O’Reilly-Jacob, M., Zolotusky, G., & DesRoches, C. M. (2018) · Medical Care · doi:10.1097/mlr.0000000000000908 · Cited by 89
Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review
Evans, C., Poku, B. A., Pearce, R., Eldridge, J., Hendrick, P. A., Knaggs, R., Blake, H., Yogeswaran, G., McLuskey, J., Tomczak, P., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-048171 · Cited by 87
Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review
Lovink, M. H., Persoon, A., Koopmans, R. T. C. M., Van Vught, A. J. A. H., Schoonhoven, L., & Laurant, M. G. H. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13299 · Cited by 83
Nurse practitioners, canaries in the mine of primary care reform
Contandriopoulos, D., Brousselle, A., Breton, M., Sangster-Gormley, E., Kilpatrick, K., Dubois, C.-A., Brault, I., & Perroux, M. (2016) · Health Policy · doi:10.1016/j.healthpol.2016.03.015 · Cited by 79
Curriculum and training needs of mid-level health workers in Africa: a situational review from Kenya, Nigeria, South Africa and Uganda
Couper, I. D., Ray, S. C., Blaauw, D., Ngwena, G., Muchiri, L. W., Oyungu, E., Omigbodun, A. O., Morhason-Bello, I. O., Ibingira, C., Tumwine, J. K., et al. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3362-9 · Cited by 76
A national survey of nurse practitioners’ patient satisfaction outcomes
Kippenbrock, T. A., Emory, J., Lee, P., Odell, E., Buron, B., & Morrison, B. (2019) · Nursing Outlook · doi:10.1016/j.outlook.2019.04.010 · Cited by 76
Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study
Poghosyan, L., Liu, J., & Norful, A. A. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.05.004 · Cited by 74
Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians
Kuo, Y., Goodwin, J. S., Chen, N., Lwin, K. K., Baillargeon, J., & Raji, M. A. (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13662 · Cited by 71
The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review
Barnett, M., Balkissoon, C. J., & Sandhu, J. (2021) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000660 · Cited by 68
Expanding clinical roles for nurses to realign the global health workforce with population needs: a commentary
Maier, C. B., & Aiken, L. H. (2016) · Israel Journal of Health Policy Research · doi:10.1186/s13584-016-0079-2 · Cited by 66
Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians
Mafi, J. N., Wee, C. C., Davis, R. B., & Landon, B. E. (2016) · Annals of Internal Medicine · doi:10.7326/m15-2152 · Cited by 65
Task-Shifting From Physicians to Nurses in Primary Care and its Impact on Resource Utilization: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Martínez-González, N. A., Rosemann, T., Djalali, S., Huber-Geismann, F., & Tandjung, R. (2015) · Medical Care Research and Review · doi:10.1177/1077558715586297 · Cited by 60
Self-citation
Universal health coverage in China part 2: addressing challenges and recommendations
Yip, W., Fu, H., Jian, W., Liu, J., Pan, J., Xu, D., Yang, H., & Zhai, T. (2023) · The Lancet Public Health · doi:10.1016/s2468-2667(23)00255-4 · Cited by 58
Determining geographic accessibility of family physician and nurse practitioner services in relation to the distribution of seniors within two Canadian Prairie Provinces
Shah, T. I., Milosavljevic, S., & Bath, B. L. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.10.019 · Cited by 58
Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model
Katzman, J. G., Galloway, K. T., Olivas, C., McCoy-Stafford, K., Duhigg, D. J., Comerci, G. D., Kalishman, S. G., Buckenmaier, C. C., McGhee, L. L., Joltes, K. H., et al. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00044 · Cited by 57
Does the Regulatory Environment Affect Nurse Practitioners’ Patterns of Practice or Quality of Care in Health Centers?
Kurtzman, E. T., Barnow, B. S., Johnson, J. E., Simmens, S. J., Infeld, D. L., & Mullan, F. (2017) · Health Services Research · doi:10.1111/1475-6773.12643 · Cited by 57
The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiaries
DesRoches, C. M., Clarke, S. P., Perloff, J. N., O’Reilly-Jacob, M., & Buerhaus, P. I. (2017) · Nursing Outlook · doi:10.1016/j.outlook.2017.06.007 · Cited by 56
Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study
van der Biezen, M., Derckx, E. W., Wensing, M., & Laurant, M. G. H. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0587-3 · Cited by 55
Self-citation
Practice patterns and role perception of advanced practice nurses: A nationwide cross‐sectional study
Woo, B., Zhou, W., Lim, T. W., & Tam, W. (2019) · Journal of Nursing Management · doi:10.1111/jonm.12759 · Cited by 60
Comparing quality of care in medical specialties between nurse practitioners and physicians
Carranza, A. N., Munoz, P. J., & Nash, A. J. (2020) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000394 · Cited by 53
Perspectives: Using Results from HRSA 's Health Workforce Simulation Model to Examine the Geography of Primary Care
Streeter, R. A., Zangaro, G. A., & Chattopadhyay, A. (2017) · Health Services Research · doi:10.1111/1475-6773.12663 · Cited by 52
Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse
Eriksson, I., Lindblad, M., Möller, U., & Gillsjö, C. (2017) · International Journal of Nursing Practice · doi:10.1111/ijn.12603 · Cited by 68
Effectiveness of nurse‐led clinics on healthcare delivery: An umbrella review
Connolly, C., & Cotter, P. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.16186 · Cited by 50
Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study
McDermott, I., Spooner, S., Goff, M., Gibson, J., Dalgarno, E., Francetic, I. N. ;., Hann, M., Hodgson, D. E., McBride, A., Checkland, K., et al. (2022) · Health and Social Care Delivery Research · doi:10.3310/ywtu6690 · Cited by 50
Integrated Memory Care Clinic: Design, Implementation, and Initial Results
Clevenger, C. K., Cellar, J., Kovaleva, M., Medders, L., & Hepburn, K. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15528 · Cited by 49
Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses
Ljungbeck, B., & Forss, K. S. (2017) · BMC Nursing · doi:10.1186/s12912-017-0258-7 · Cited by 47
Effects of Advanced Practice Providers on Single-specialty Surgical Practice
Hollenbeck, B. K., Kaufman, S. R., Oerline, M., Modi, P. K., Caram, M. E. V., Shahinian, V. B., & Ellimoottil, C. S. (2021) · Annals of Surgery · doi:10.1097/sla.0000000000004846 · Cited by 48
Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review
Speight, C., Firnhaber, G. C., Scott, E. S., & Wei, H. (2019) · Nursing Forum · doi:10.1111/nuf.12370 · Cited by 46
Primary healthcare policy and governance in low-income and middle-income countries: an evidence gap map
Saif‐Ur‐Rahman, K., Mamun, R., Nowrin, I., Hossain, S., Islam, K., Rumman, T., Kabir, A. E., Rahman, A., Dahal, N., & Anwar, I. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2019-001453 · Cited by 46
Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study
van der Biezen, M., Schoonhoven, L., Wijers, N., van der Burgt, R., Wensing, M., & Laurant, M. G. H. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.12954 · Cited by 45
Self-citation
Relations between task delegation and job satisfaction in general practice: a systematic literature review
Riisgaard, H., Nexøe, J., Le, J. V., Søndergaard, J., & Ledderer, L. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0565-1 · Cited by 45
Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011–19
Cai, A., Mehrotra, A., Germack, H. D., Busch, A. B., Huskamp, H. A., & Barnett, M. L. (2022) · Health Affairs · doi:10.1377/hlthaff.2022.00289 · Cited by 43
Establishing the nurse practitioner workforce in rural New Zealand: barriers and facilitators
Adams, S., & Carryer, J. (2019) · Journal of Primary Health Care · doi:10.1071/hc18089 · Cited by 43
Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management
Courtenay, M., Rowbotham, S. J., Lim, R. H. M., Deslandes, R. E., Hodson, K., MacLure, K., Peters, S., & Stewart, D. C. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013515 · Cited by 42
Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India
Kavita, K., Thakur, J. S., Vijayvergiya, R., & Ghai, S. (2020) · BMC Health Services Research · doi:10.1186/s12913-019-4864-9 · Cited by 45
Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study
Harding, P. A., Prescott, J., Block, L., O’Flynn, A. M., & Burge, A. T. (2015) · Australian Health Review · doi:10.1071/ah14207 · Cited by 41
Geographic Distribution of Nonphysician Clinicians Who Independently Billed Medicare for Common Dermatologic Services in 2014
Adamson, A. S., Suarez, E. A., McDaniel, P. M., Leiphart, P. A., Zeitany, A., & Kirby, J. S. (2017) · JAMA Dermatology · doi:10.1001/jamadermatol.2017.5039 · Cited by 41
Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries
Razavi, M., O’Reilly-Jacob, M., Perloff, J. N., & Buerhaus, P. I. (2020) · Medical Care · doi:10.1097/mlr.0000000000001477 · Cited by 43
Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study
Mann, C., Timmons, S., Evans, C., Pearce, R., Overton, C., Hinsliff‐Smith, K., & Conway, J. H. (2023) · Nurse Education in Practice · doi:10.1016/j.nepr.2023.103546 · Cited by 40
Inequal distribution of nursing personnel: a subnational analysis of the distribution of nurses across 58 countries
Boniol, M., McCarthy, C. F., Lawani, D., Guillot, G., McIsaac, M., & Diallo, K. (2022) · Human Resources for Health · doi:10.1186/s12960-022-00720-5 · Cited by 40
Integration of nurses in general practice: A thematic synthesis of the perspectives of general practitioners, practice nurses and patients living with chronic illness
Aerts, N., Bogaert, P. V., Bastiaens, H., & Peremans, L. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.15092 · Cited by 39
Patients’ experiences with the advanced practice nurse role in Swiss family practices: a qualitative study
Schönenberger, N., Sottas, B., Merlo, C., Essig, S., & Gysin, S. (2020) · BMC Nursing · doi:10.1186/s12912-020-00482-2 · Cited by 38
The effect of nurse practitioner scope of practice laws on primary care delivery
Smith, L. B. (2021) · Health Economics · doi:10.1002/hec.4438 · Cited by 42
Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach
Feiring, E., & Lie, A. E. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3719-0 · Cited by 36
Analytical typology of multiprofessional primary care models
Contandriopoulos, D., Perroux, M., Cockenpot, A., Duhoux, A., & Jean, E. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0731-8 · Cited by 36
Who Should Deliver Primary Care in Long-term Care Facilities to Optimize Resident Outcomes? A Systematic Review
Barker, R., Craig, D., Spiers, G., Kunonga, P., & Hanratty, B. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.07.006 · Cited by 38
Evidence and rhetoric about access to UK primary care
Cowling, T. E., Harris, M. J., & Majeed, A. (2015) · BMJ · doi:10.1136/bmj.h1513 · Cited by 34
Nursing Practice in Primary Care and Patients’ Experience of Care
Silva, R. B. D., Brault, I., Pineault, R., Chouinard, M., Prud’homme, A., & D’Amour, D. (2018) · Journal of Primary Care & Community Health · doi:10.1177/2150131917747186 · Cited by 34
The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study
van der Biezen, M., Adang, E., van der Burgt, R., Wensing, M., & Laurant, M. G. H. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0528-6 · Cited by 33
Self-citation
Expansion of the interprofessional clinical practice of Primary Care nurses
Peduzzi, M., Aguiar, C., Lima, A. M. V., Montanari, P. M., Leonello, V. M., & de Oliveira, M. R. (2019) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2017-0759 · Cited by 33
Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews
Jessup, R. L., Putrik, P., Buchbinder, R., Nezon, J., Rischin, K. J., Cyril, S., Shepperd, S., & O’Connor, D. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036112 · Cited by 33
Utilization and Costs by Primary Care Provider Type
Smith, V. A., Morgan, P., Edelman, D. E., Woolson, S., Berkowitz, T. S. Z., Houtven, C. H. V., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2020) · Medical Care · doi:10.1097/mlr.0000000000001326 · Cited by 33
Exploring nursing competence to care for older patients in municipal in‐patient acute care: A qualitative study
Vatnøy, T. K., Karlsen, T., & Dale, B. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.14914 · Cited by 32
Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study
van der Biezen, M., Wensing, M., Poghosyan, L., van der Burgt, R., & Laurant, M. G. H. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2548-x · Cited by 32
Self-citation
Integrated older people care and advanced practice nursing: an evidence‐based review
Prajankett, O.-O., & Markaki, A. (2020) · International Nursing Review · doi:10.1111/inr.12606 · Cited by 30
Effects of task-shifting from primary care physicians to nurses: an overview of systematic reviews
Paier-Abuzahra, M., Posch, N., Jeitler, K., Semlitsch, T., Radl-Karimi, C., Spary-Kainz, U., Horvath, K., & Siebenhofer, A. (2024) · Human Resources for Health · doi:10.1186/s12960-024-00956-3 · Cited by 29
A compreensão da prática avançada de enfermagem como um passo à sua implementação no Brasil
Andriola, I. C., Sonenberg, A., & Lira, A. L. B. D. C. (2020) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2020.115 · Cited by 29
Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists
Stute, M., Moretto, N., Waters, R. M., Raymer, M. E., Sam, S., Bhagwat, M., Banks, M., Comans, T. A., & Buttrum, P. J. (2020) · Australian Health Review · doi:10.1071/ah19225 · Cited by 29
Consultations in general practices with and without mental health nurses: an observational study from 2010 to 2014
Magnée, T., Beurs, D. P. D., de Bakker, D. H., & Verhaak, P. F. M. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011579 · Cited by 29
Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial
Gerritsen, A., de Rooij, T., Dijkgraaf, M. G. W., Busch, O. R., Bergman, J. J. G. H. M., Ubbink, D. T., van Duijvendijk, P., Erkelens, W. G., Klos, M., Kruyt, P. M., et al. (2016) · The American Journal of Gastroenterology · doi:10.1038/ajg.2016.224 · Cited by 28
Skill mix in Swiss primary care group practices - a nationwide online survey
Josi, R., & Pietro, C. D. (2019) · BMC Family Practice · doi:10.1186/s12875-019-0926-7 · Cited by 28
The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners’ experiences
Taylor, I., Bing‐Jonsson, P. C., Johansen, E. A., Levy‐Malmberg, R., & Fagerström, L. (2019) · Nurse Education in Practice · doi:10.1016/j.nepr.2019.04.001 · Cited by 28
Open education resources to support the WHO nurse educator core competencies
Berland, A., Capone, K., Etcher, L., Ewing, H., Keating, S., & Chickering, M. J. (2020) · International Nursing Review · doi:10.1111/inr.12583 · Cited by 27
Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review
Horton, M., Dixon, J., Turi, E. R., Balusu, C., Paikoff, R., Maier, C. B., & Poghosyan, L. (2024) · Journal of Clinical Nursing · doi:10.1111/jocn.17614 · Cited by 26
Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands
Rutten, M., Vrielink, F., Smits, M., & Giesen, P. H. J. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0633-1 · Cited by 26
Nurse practitioners’ job satisfaction in rural versus nonrural areas
Bae, S. (2016) · Journal of the American Association of Nurse Practitioners · doi:10.1002/2327-6924.12362 · Cited by 25
Substitution of low-risk skin cancer hospital care towards primary care: A qualitative study on views of general practitioners and dermatologists
Noels, E., Wakkee, M., van den Bos, R. R., Bindels, P., Nijsten, T. E. C., & Lugtenberg, M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213595 · Cited by 25
‘Thinking outside the box’: advanced geriatric nursing in primary health care in Scandinavia
Boman, E., Glasberg, A., Levy‐Malmberg, R., & Fagerström, L. (2019) · BMC Nursing · doi:10.1186/s12912-019-0350-2 · Cited by 25
Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study
Woo, B., Koh, K. W. L., Zhou, W., Lim, T. W., López, V., & Tam, W. (2020) · Journal of Clinical Nursing · doi:10.1111/jocn.15224 · Cited by 25
Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual
Verberne, D. P. J., Kroese, M., Staals, J., Ponds, R., & Heugten, C. M. V. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1849417 · Cited by 25
The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review
Deschodt, M., Heeren, P., Cerulus, M., Duerinckx, N., Pape, E., van Achterberg, T., Vanclooster, A., Dauvrin, M., Detollenaere, J., den Heede, K. V., et al. (2024) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2024.104840 · Cited by 25
Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England
Collins, D. (2018) · Journal of Nursing Management · doi:10.1111/jonm.12680 · Cited by 25
Historical and theoretical perspectives
(2022) · Cambridge University Press eBooks · doi:10.1017/9781009047784.003 · Cited by 24
The influence of registered nurses and nurse practitioners on patient experience with primary care: results from the Canadian QUALICO-PC study
Ammi, M., Ambrose, S., Hogg, B., & Wong, S. T. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.09.019 · Cited by 23
What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey
Paddison, C. A. M., Abel, G., Burt, J., Campbell, J. L., Elliott, M. N., Lattimer, V., & Roland, M. O. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-018690 · Cited by 23
Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review
Cody, R., Gysin, S., Merlo, C., Gemperli, A., & Essig, S. (2020) · BMC Family Practice · doi:10.1186/s12875-020-1089-2 · Cited by 23
Practice nurse support and task suitability in a general practice: a cross-sectional survey in Belgium
Matthys, E., Remmen, R., & Bogaert, P. V. (2019) · Journal of Interprofessional Care · doi:10.1080/13561820.2019.1569602 · Cited by 22
After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density
Markowski, J. H., Wallace, J., & Ndumele, C. D. (2023) · Health Affairs · doi:10.1377/hlthaff.2023.00478 · Cited by 22

Authors: Martínez-González, N. A., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing, M., & Rosemann, T.
Affiliations: University Hospital Zurich (CH)
Radboud University Medical Center (NL)
Corresponding author: Rosemann, Thomas
ORCID: Martínez-González, Nahara Anani
Djalali, Sima
Markun, Stefan
Wensing, Michel
Rosemann, Thomas
Venue: BMC Health Services Research
Publisher: Springer Science and Business Media LLC
Published: 2014-05-12
Volume: 14
Issue: 1
Pages: 214-214
ISSN: 1472-6963 (ISSN-L)
DOI: 10.1186/1472-6963-14-214
PMC: PMC4065389
OpenAlex: W2138392956
Cited by: 310
References: 50
Citations by year: 2026: 10 · 2025: 18 · 2024: 26 · 2023: 24 · 2022: 26 · 2021: 24 · 2020: 36 · 2019: 35 · 2018: 28 · 2017: 36 · 2016: 25 · 2015: 19 · 2014: 2
FWCI: 4.65
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Health Services Research (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Radboud Repository (Radboud University) (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
Zurich Open Repository and Archive (University of Zurich)
Funders: Schweizerische Akademie der Medizinischen Wissenschaften
Topics: Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Health Sciences › Nursing › Research and Theory › Nursing education and management
Keywords: nurse-led care, primary care, nurse practitioners, registered nurses, licensed nurses, patient satisfaction, hospitalization, mortality, quality of life, health care costs, physician shortage
MeSH terms: Workforce, Clinical Competence, Delivery of Health Care, Hospitalization, Humans, Medical Staff, Hospital, Nursing Staff, Hospital, Personnel Staffing and Scheduling, Primary Health Care, Quality of Life, Randomized Controlled Trials as Topic, Patient Satisfaction, Personnel Delegation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Abstract

Overview

Integrity signals

Figures

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks