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

Items 101–200 of 308

Four-year long-term follow-up of diabetes patients after implementation of the Chronic Care Model in primary care: a cross-sectional study
Chmiel, C., Giewer, I., Frei, A. L., & Rosemann, T. J. (2017) · Swiss Medical Weekly · doi:10.4414/smw.2017.14522 · Cited by 22
Self-citation
The Acceptability of Task-Shifting from Doctors to Allied Health Professionals
Jedro, C., Holmberg, C., Tille, F., Widmann, J., Schneider, A., Stumm, J., Döpfmer, S., Kuhlmey, A., & Schnitzer, S. (2020) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2020.0583 · Cited by 22
Pathways to Enable Primary Healthcare Nurses in Providing Comprehensive Primary Healthcare to Rural, Tribal Communities in Rajasthan, India
Amin, A., Dutta, M., Mohan, S. B., & Mohan, P. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.583821 · Cited by 21
A systematic review of pre-service training on vaccination and immunization
Tchoualeu, D. D., Fleming, M. K., & Traicoff, D. A. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.03.062 · Cited by 21
Feasibility and Impact of Doctor-Nurse Task Delegation in Preventive Child Health Care in the Netherlands, a Controlled Before-After Study
Benjamins, J., Damen, M. L. W., & van Stel, H. F. (2015) · PLoS ONE · doi:10.1371/journal.pone.0139187 · Cited by 21
Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician
Agarwal, A., Zhang, W., Kuo, Y., & Sharma, G. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148522 · Cited by 21
Directing Improvements in Primary Care Patient Experience through Analysis of Service Quality
Smith, M. H., & Smith, D. A. (2018) · Health Services Research · doi:10.1111/1475-6773.12985 · Cited by 21
Integration of an advanced practice nurse into a primary care practice: a qualitative analysis of experiences with changes in general practitioner professional roles in a Swiss multiprofessional primary care practice
Lauber, E., Kindlimann, A., Nicca, D., Arb, R. A.-V., Sgier, C., Staudacher, S., Schramm, M. S., Vökt, F., & Zúñiga, F. (2022) · Swiss Medical Weekly · doi:10.4414/smw.2022.w30199 · Cited by 23
How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector
Adams, S., & Carryer, J. (2020) · Policy Politics & Nursing Practice · doi:10.1177/1527154420965534 · Cited by 20
US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis
Mafi, J. N., Chen, A., Guo, R., Choi, K. R., Smulowitz, P. B., Tseng, C., Ladapo, J. A., & Landon, B. E. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-055138 · Cited by 20
Ein evidenzbasiertes Gesundheitssystem: die Rolle der Gesundheitsfachberufe
Meyer, G. (2015) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2015.07.014 · Cited by 20
The Organizational Climate for Nurse Practitioners Working in Primary Health Care in New Zealand: A National Survey
Adams, S., Mustafa, M., Bareham, C. A., Carryer, J., Tenbensel, T., & Poghosyan, L. (2022) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2022.04.024 · Cited by 19
Opioid Prescribing by Nurse Practitioners in Medicare Part D: Impact of State Scope of Practice Legislation
Ladd, E., Sweeney, C. F., GUARINO, A. J., & Hoyt, A. (2017) · Medical Care Research and Review · doi:10.1177/1077558717725604 · Cited by 19
Original Research
Baron, A. M., Ridgeway, J. L., Stirn, S. L., Morris, M. A., Branda, M. E., Inselman, J., Finnie, D. M., & Baker, C. A. (2017) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000529715.93343.b0 · Cited by 19
Étude exploratoire de la perception des parties prenantes hospitalières vis-à-vis de l’implantation des infirmiers en pratique avancée
Schwingrouber, J., Loschi, A., Gentile, S., & Colson, S. (2021) · Recherche en soins infirmiers · doi:10.3917/rsi.145.0104 · Cited by 19
The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS
Pilvar, H., & Watt, T. (2024) · The European Journal of Health Economics · doi:10.1007/s10198-024-01742-7 · Cited by 18
The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis
Turner, A., Mulla, A., Booth, A., Aldridge, S., Stevens, S., Begum, M., & Malik, A. (2018) · Health Services and Delivery Research · doi:10.3310/hsdr06250 · Cited by 18
Nurse‒physician interprofessional collaboration in the context of expanding nursing practice in primary health care: A comparative qualitative study of Brazil and Germany
Franco, C. M., Bula, D. A., Toso, B. R. G. D. O., Giovanella, L., & Hämel, K. (2025) · BMC Nursing · doi:10.1186/s12912-025-02885-5 · Cited by 17
Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study
Gygli, N., Zúñiga, F., & Simon, M. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06876-5 · Cited by 17
How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
Hutchinson, J., Lau, Y., Sutton, M., & Checkland, K. (2023) · British Journal of General Practice · doi:10.3399/bjgp.2023.0007 · Cited by 17
Improving access to school health services as perceived by school professionals
Bezem, J., Heinen, D., Reis, R., Buitendijk, S. E., Numans, M. E., & Kocken, P. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2711-4 · Cited by 17
Designing a nurse‐led assessment and care planning intervention to support frail older people in primary care: An e‐Delphi study
Lyndon, H., Latour, J. M., Marsden, J. F., & Kent, B. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.15066 · Cited by 16
Perceptions and Expectations of Advanced Geriatric Nursing Role Development in Primary Health Care: A Qualitative Study Exploring Staff’s Perspectives
Li, Y., Chen, M., Lin, R., & Li, H. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s343622 · Cited by 16
Perception and Experience of Independent Consultations in Primary Healthcare among Registered Nurses in Kazakhstan: A Qualitative Study
Dostanova, Z. A., Yermukhanova, L. S., Blaževičienė, A., Baigozhina, Z., Taushanova, M., Абдикадирова, И. Т., & Sultanova, G. (2024) · Healthcare · doi:10.3390/healthcare12151461 · Cited by 16
Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional‐led primary care
Walker, A., Williams, R., Sibley, F., Stamp, D., Carter, A., & Hurley, M. (2017) · Musculoskeletal Care · doi:10.1002/msc.1189 · Cited by 16
Substitution of general practitioners by nurse practitioners in out-of-hours primary care home visits: A quasi-experimental study
Smits, M., Peters, Y., Ranke, S., Plat, E., Laurant, M. G. H., & Giesen, P. H. J. (2019) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2019.103445 · Cited by 16
Introducing Nurse Practitioners Into Norwegian Primary Healthcare—Experiences and Learning
Hansen, E. H., Boman, E., Bing‐Jonsson, P. C., & Fagerström, L. (2020) · Research and theory for nursing practice · doi:10.1891/1541-6577.34.1.21 · Cited by 16
Parent Satisfaction With Pediatric Nurse Practitioner Care in Specialty Services
Thibodeau, B. A. M., Southon, S. H., Beaudoin, W., Jurasek, L., Perry, S., Dorfman, T., Issel, J., Johnston, K., & Olmstead, D. (2022) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2022.04.004 · Cited by 15
Effect of community‐based nurse‐led support intervention in the reduction of HbA1c levels
Li, J., Yang, F., Wang, J., & Tao, Y. (2022) · Public Health Nursing · doi:10.1111/phn.13119 · Cited by 15
Formalisation and subordination: a contingency theory approach to optimising primary care teams
Contandriopoulos, D., Perroux, M., & Duhoux, A. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-025007 · Cited by 15
Desarrollo competencial de las enfermeras en el sistema sanitario público de Andalucía
Robles, N. L., Fernández‐Salazar, S., Rodríguez‐Gómez, S., Casado-Mora, M. I., Morales‐Asencio, J. M., & Ramos‐Morcillo, A. J. (2019) · Enfermería Clínica · doi:10.1016/j.enfcli.2018.12.013 · Cited by 15
Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland
Casey, M., O’Connor, L., Rohde, D., Twomey, L., Cullen, W., & Carroll, Á. M. (2022) · Health Science Reports · doi:10.1002/hsr2.555 · Cited by 15
Meta-synthesis on nurse practitioner autonomy and roles in ambulatory care
Wang-Romjue, P. B. (2017) · Nursing Forum · doi:10.1111/nuf.12236 · Cited by 15
A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study
Lake, J. D., Barnsley, J. M., Lofters, A., & Austin, Z. (2024) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2024.04.016 · Cited by 15
Implementation of advanced practice nursing for minor orthopedic injuries in the emergency care context: A non-inferiority study
Boman, E., Duvaland, E., Gaarde, K., Leary, A., Rauhala, A., & Fagerström, L. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2021.103910 · Cited by 14
Employing nurse practitioners in general practice: an exploratory survey of the perspectives of managers
Mustafa, M., Adams, S., Bareham, C. A., & Carryer, J. (2021) · Journal of Primary Health Care · doi:10.1071/hc21036 · Cited by 14
Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care: A nominal group technique approach
Newham, R., Weir, N., Ferguson, A., & Bennie, M. (2022) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2022.11.003 · Cited by 14
Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program
Senay, A., Delisle, J., Raynauld, J., Morin, S. N., & Fernandes, J. (2015) · Osteoporosis International · doi:10.1007/s00198-015-3413-6 · Cited by 15
Efficiency of the implementation of cardiovascular risk management in primary care practices: an observational study
Adang, E., Gerritsma, A., Nouwens, E., van Lieshout, J., & Wensing, M. (2015) · Implementation Science · doi:10.1186/s13012-016-0434-2 · Cited by 14
Self-citation
How well do public sector primary care providers function as medical generalists in Cape Town: a descriptive survey
Christoffels, R., & Mash, R. J. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0802-x · Cited by 14
Gezielte Entwicklung von Advanced Practice Nurse-Rollen für spezifische Patient(inn)engruppen in einem Schweizer Universitätsspital
Spichiger, E., Shaha, M., Schubert, M., & Herrmann, L. (2018) · Pflege · doi:10.1024/1012-5302/a000594 · Cited by 14
Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis
Moran, V., Suhrcke, M., & Nolte, E. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-10369-y · Cited by 13
Task shifting from general practitioners to other health professionals in out-of-hours primary care – a systematic literature review on content and quality of task shifting
Bomholt, K. B., Nebsbjerg, M. A., Burau, V., Mygind, A., Christensen, M. B., & Huibers, L. (2024) · European Journal of General Practice · doi:10.1080/13814788.2024.2351807 · Cited by 13
What will make a difference? Assessing the impact of policy and non-policy scenarios on estimations of the future GP workforce
Laurence, C., & Karnon, J. D. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0216-1 · Cited by 13
Breast Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multi-Level Analysis of Barriers and Facilitators
Wang, H., Gregg, A., Qiu, F., Kim, J., Chen, B., Wan, N., Su, D., Michaud, T. L., & Chen, L. (2017) · Journal of Community Health · doi:10.1007/s10900-017-0412-x · Cited by 13
Nurses in Family Pediatric Practices: A Survey of the Health Protection Agency of the Metropolitan City of Milan
Bezze, 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
Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies
Lyness, E., Parker, J., Willcox, M. L., & Dambha‐Miller, H. (2021) · BJGP Open · doi:10.3399/bjgpo.2021.0043 · Cited by 13
Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006
van den Hombergh, P., van Doorn-Klomberg, A. L., Campbell, S., Wensing, M., & Braspenning, J. C. C. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0519-7 · Cited by 13
Self-citation
Towards an optimal composition of general practitioners and nurse practitioners in out-of-hours primary care teams: a quasi-experimental study
van der Biezen, M., Wensing, M., van der Burgt, R., & Laurant, M. G. H. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015509 · Cited by 13
Self-citation
Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual
Verberne, D. P. J., van Mastrigt, G. A. P. G., Ponds, R., Heugten, C. M. V., & Kroese, M. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-039201 · Cited by 13
Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens
Komene, E., Davis, J., Davis, R., O'Dwyer, R., Pou, K. T., Dick, C., Sami, L., Wiapo, C., & Adams, S. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16334 · Cited by 12
Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
Mangenah, C., Mavhu, W. M., Hatzold, K., Biddle, A. K., Ncube, G., Mugurungi, O. M., Ticklay, I., Cowan, F. M., & Thirumurthy, H. (2016) · Global Health Science and Practice · doi:10.9745/ghsp-d-15-00201 · Cited by 12
The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio
Martsolf, G. R., Auerbach, D. I., & Arifkhanova, A. (2015) · Cited by 12
A legal framework on advanced practice nursing in Belgium: what do we and don’t we know?
Hecke, A. V., Bogaert, P. V., Decoene, E., Dobbels, F., Goossens, E., Goossens, G. A., Verhaeghe, S. T. L., & Goffin, T. (2020) · Acta Clinica Belgica · doi:10.1080/17843286.2020.1795575 · Cited by 11
Outcomes of Hematuria Evaluation by Advanced Practice Providers and Urologists
Hyman, M. J., Skolarus, T. A., Litwack, K., Meltzer, D. O., & Modi, P. K. (2023) · Urology · doi:10.1016/j.urology.2023.03.049 · Cited by 11
Self-assessment of nursing competency among final year nursing students in Thailand: a comparison between public and private nursing institutions
Sawaengdee, K., Kantamaturapoj, K., Seneerattanaprayul, P., Putthasri, W., & Suphanchaimat, R. (2016) · Advances in Medical Education and Practice · doi:10.2147/amep.s111026 · Cited by 11
Primary Care Providers’ Intended Use of Decision Aids for Prostate-Specific Antigen Testing for Prostate Cancer Screening
Rim, S. H., Hall, I. J., Massetti, G. M., Thomas, C. C., Li, J., & Richardson, L. C. (2018) · Journal of Cancer Education · doi:10.1007/s13187-018-1353-5 · Cited by 11
Patient Satisfaction with Physicians and Nurse Practitioners in Multiple Sclerosis Centers
Thotam, S., & Buhse, M. (2019) · International Journal of MS Care · doi:10.7224/1537-2073.2018-042 · Cited by 11
Interprofessional Teams: Lessons Learned From a Nurse-Led Clinic
Schentrup, D. M., Black, E. W., Blue, A. V., & Whalen, K. (2019) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2019.02.016 · Cited by 11
The training and education of nurse practitioners in Aotearoa New Zealand: Time for nationwide refresh
Adams, S., Oster, S., & Davis, J. (2022) · Nursing Praxis in Aotearoa New Zealand · doi:10.36951/27034542.2022.01 · Cited by 10
A lack of nurse autonomy impacts population health when compared to physician care: an ecological study
You, W., Cusack, L., & Donnelly, F. (2023) · Scientific Reports · doi:10.1038/s41598-023-38945-6 · Cited by 10
The effect of general practice team composition and climate on staff and patient experiences: a systematic review
Abrams, R., Jones, B., Campbell, J., de Lusignan, S., Peckham, S., & Gage, H. (2023) · BJGP Open · doi:10.3399/bjgpo.2023.0111 · Cited by 10
Productivity in the NHS: why it matters and what to do next
Dixon, J., Street, A., & Allwood, D. (2018) · BMJ · doi:10.1136/bmj.k4301 · Cited by 10
Allgemeine Palliativversorgung in der hausärztlichen Praxis: Entwicklung von Strategien zur Verbesserung struktureller, rechtlicher und finanzieller Rahmenbedingungen
Ewertowski, H., Hesse, A., Schneider, N., & Stiel, S. (2019) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2019.12.003 · Cited by 10
Use of a State Registry to Compare Practices of Physicians and Nurse Practitioners in Completing Physician Orders for Life-Sustaining Treatment Forms
Constantine, L., Wang, K., Funk, D. C., Speis, A., & Moss, A. H. (2020) · Journal of Palliative Medicine · doi:10.1089/jpm.2020.0515 · Cited by 10
Implementation of a new model of nursing service management in health organizations to increase the effectiveness of nursing professionals and their contribution to protecting public health in the Republic of Kazakhstan: Policy Brief
Baygozhina, Z., Koikov, V., Umbetzhanova, A., & Bekbergenova, Z. (2020) · Journal of Health Development · doi:10.32921/2225-9929-2020-36-69-83 · Cited by 9
Health care use in response to health shocks: Does socio‐economic status matter?
Fiebig, D. G., Gool, K. V., Hall, J. P., & Mu, C. (2021) · Health Economics · doi:10.1002/hec.4427 · Cited by 9
Experiences of an interprofessional follow-up program in primary care practice
Kolltveit, B. H., Oftedal, B. F., Thorne, S. E., Lomborg, K. E., & Graue, M. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-10706-9 · Cited by 8
Competential development of nurses in the public health system of Andalucía
Robles, N. L., Fernández‐Salazar, S., Rodríguez‐Gómez, S., Casado-Mora, M. I., Morales‐Asencio, J. M., & Ramos‐Morcillo, A. J. (2019) · Enfermería Clínica (English Edition) · doi:10.1016/j.enfcle.2018.12.004 · Cited by 8
Clinicians' psychological empowerment to engage in management as part of their daily work
Andersson, T., Eriksson, N., & Müllern, T. (2022) · Journal of Health Organization and Management · doi:10.1108/jhom-08-2021-0300 · Cited by 8
Clinical profile and care pathways among unaccompanied minor asylum seekers in Vaud, Switzerland
Genton, P. C., Wang, J., Bodenmann, P., & Ambresin, A. (2019) · International Journal of Adolescent Medicine and Health · doi:10.1515/ijamh-2019-0140 · Cited by 8
Wound management provided by advanced practice nurses: a scoping review
Morrell, S., Pittman, G., Elliott, R., Ziegler, E., Borawski, S., Mulcaster, A., Hebert, A., Patel, T., & Dannawey, A. (2023) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00019 · Cited by 7
A Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations
UNDERWOOD, P. C., Ruscitti, B., Nguyen, T. H., Magny‐Normilus, C., Wentzell, K., Watts, S. A., & H, D. B. M. P. (2025) · Health Systems & Reform · doi:10.1080/23288604.2025.2503648 · Cited by 8
The High Cost of American Health Care: Understanding the Deeper Roots of the Crisis
Chang, C. F., Mirvis, D. M., & Mahmood, A. (2025) · Health Care Analysis · doi:10.1007/s10728-025-00554-x · Cited by 7
Conceptual framework for acute community health care services – Illustrated by assessing the development of services in Denmark
Fournaise, A., Andersen‐Ranberg, K., Lauridsen, J. T., Espersen, K., Gudex, C. M., & Bech, M. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.115857 · Cited by 7
“Cooperation between physicians and physios fosters trust you know”: a qualitative study exploring patients’ experience with first-contact physiotherapy for low back pain in French primary care
Kechichian, A., Pommier, D., Druart, L., Lowry, V., Pinsault, N., & Desmeules, F. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02302-x · Cited by 7
Physician substitution by mid‐level providers in primary healthcare for older people and long‐term care facilities: protocol for a systematic literature review
Lovink, M. H., Persoon, A., van Vught, A., Koopmans, R. T. C. M., Schoonhoven, L., & Laurant, M. G. H. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12759 · Cited by 7
Advanced Practice Nursing in New Zealand
Carryer, J., & Adams, S. (2020) · Advanced practice in nursing · doi:10.1007/978-3-030-20550-8_11 · Cited by 7
Impact of advanced practice providers on characteristics and quality of care of patients with chronic hepatitis B
Kam, L. Y., Huang, D. Q., Tobias, A. F., Poon, K., Henry, L. L., Kwo, P. Y., Cheung, R. C., & Nguyen, M. H. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17254 · Cited by 7
Antenatal cardiotocography in dutch primary midwife-led care: Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study
Neppelenbroek, E. M., Verhoeven, C. J. M., van der Heijden, O. W. H., van der Pijl, M. S. G., Groenen, C. J. M., Ganzevoort, W., Bijvank, B. S. W. A. N., & de Jonge, A. (2023) · Women and Birth · doi:10.1016/j.wombi.2023.08.006 · Cited by 7
Triage in preventive child healthcare: a prospective cohort study of care use and referral rates for children at risk
Bezem, J., Kocken, P., Kamphuis, M., Theunissen, M. H. C., Buitendijk, S. E., & Numans, M. E. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016423 · Cited by 7
Do State Restrictions on Advanced Practice Registered Nurses Impact Patient Outcomes for Hypertension and Diabetes Control?
Grimes, D. E., Thomas, E. J., Padhye, N. S., Ottosen, M. J., & Grimes, R. M. (2018) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2018.06.005 · Cited by 7
The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations
McMichael, B. J. (2025) · Journal of Health Economics · doi:10.1016/j.jhealeco.2025.103044 · Cited by 6
Development of a nurse-led mHealth intervention framework for patients with chronic diseases: A systematic review and Delphi study
Hua, J., Sun, D., Wang, H., Chang, J., Guo, F., Zhou, Q. H., Hui, N., Gu, D., & Zhu, L. (2025) · Digital Health · doi:10.1177/20552076251387050 · Cited by 6
Zwischen neuer Verantwortung und Routinetätigkeit: Die Rolle der VERAH in der hausärztlichen Versorgung – Eine qualitative Sekundärdatenanalyse am Beispiel des softwaregestützten Case Management
Forstner, J., Mangold, J., Litke, N. A., Weis, A., Szécsényi, J., Wensing, M., & Ullrich, C. (2023) · Das Gesundheitswesen · doi:10.1055/a-2144-5767 · Cited by 6
Self-citation
The changing shape of general practice in Scotland: the rise of the ‘megapractice’
McCartney, G., Johnstone, C., & Dover, L. (2024) · Public Health · doi:10.1016/j.puhe.2024.05.026 · Cited by 6
Implementing the ACA: The Influence of Nurse Practitioner Regulatory Policies on Workforce, Access to Care, and Primary Care Health Outcomes
Sonenberg, A., Knepper, H. J., & Pulcini, J. A. (2015) · Poverty & Public Policy · doi:10.1002/pop4.119 · Cited by 6
Wound Closure Rates: A Comparison Between Advanced Practice Registered Nurse and Primary Care Physician Treatment
Gonzalez, A., Delgado, V., & Buscemi, C. P. (2019) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2019.04.015 · Cited by 6
Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies
Boman, E., Duvaland, E., Gaarde, K., Leary, A., & Fagerström, L. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14299 · Cited by 6
The Evolution and Future of Nurse Practitioners in New Zealand
Adams, S., & Carryer, J. (2023) · Advanced practice in nursing · doi:10.1007/978-3-031-20762-4_19 · Cited by 6
Patient perspective on task shifting from general practitioners to medical practice assistants – a quantitative survey in Germany
Kuschick, D., Dierks, M. T., Grittner, U., Heintze, C., Kümpel, L., Riens, B., Rost, L., Schmidt, K. F. R., Schulze, D., Toutaoui, K. J., et al. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02211-5 · Cited by 6
A Medicare Current Beneficiary Survey–Based Investigation of Alternative Primary Care Models in Nursing Homes: Functional Ability and Health Status Outcomes
Abdallah, L., Etten, D. V., Lee, A. J., Melillo, K. D., Remington, R., Gautam, R., & Gore, R. J. (2015) · Research in Gerontological Nursing · doi:10.3928/19404921-20150121-01 · Cited by 6
Inter‐ and intraobserver agreement of antenatal cardiotocography assessments by maternity care professionals: A prospective study
Neppelenbroek, E. M., van der Heijden, O. W. H., de Vet, H. C. W., Groot, A. D., Daemers, D. O. A., de Jonge, A., & Verhoeven, C. J. M. (2024) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.15497 · Cited by 6
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
“11,19,21,26,27,29,30,33,34 There also are some robust studies comparing the cost of care provided by nurses — generally NPs — to the cost of care provided by physicians.”
Background
Healthcare resource utilization and costs in stable patients with rheumatoid arthritis: Comparing nurse-led and rheumatologist-led models of care delivery
Lopatina, E., Barber, C. E. H., LECLERCQ, S. A., Noseworthy, T., Suter, E., Mosher, D. P., & Marshall, D. A. (2022) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2022.152160 · Cited by 5
Nurse Practitioners as Disruptive Innovators in Palliative Medicine
Opitz, S. E., & Hebert, R. S. (2018) · Journal of Palliative Care · doi:10.1177/0825859718785227 · Cited by 5
Experiences and views of midwives performing antenatal cardiotocography in Dutch primary care: A qualitative study
van der Pijl, M. S. G., Groenestege, E. Q. T., & Verhoeven, C. J. M. (2019) · Midwifery · doi:10.1016/j.midw.2019.02.003 · Cited by 5
How nurse-led practices perceive implementation of the patient-centered medical home
Frasso, R., Golinkoff, J., Klusaritz, H. A., Kellom, K. S., Kollar-McArthur, H., Miller-Day, M. A., Gabbay, R. A., & Cronholm, P. F. (2017) · Applied Nursing Research · doi:10.1016/j.apnr.2017.02.005 · Cited by 5
The trend in density of skilled health personnel in BRICS countries: Implication for China and India
Yan, F., Li, H., Wang, W., & Zhang, J. (2023) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3623 · Cited by 4
Task shifting from general practitioners to nurses in out-of-hours primary care: an explorative case study of team-based practices
Bomholt, K. B., Mygind, A., Nebsbjerg, M. A., Christensen, M. B., Huibers, L., & Burau, V. (2025) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2025.2490911 · Cited by 4

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