Tuesday, 15 March 2016

Are doctors as good as nurses?

Roger Watson, Editor-in-Chief

Can doctors be substituted by nurses?  This alluring possibility has caught the imagination of health services in several countries mainly, it has to be said, because it is likely to be cheaper.  This study from The Netherlands by van der Biezen et al. (2016) titled: 'Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study' and published in JAN reports on a study of the substitution of general practitioners (GPs) by nurse practitioners (NPs).

The aim of the study was to: 'provide insight into the impact of substituting general practitioners with
nurse practitioners in out-of-hours services' and the number of patients and their characteristics were studied as outcomes using data from over 12,000 patient records.  The results showed that: 'General
practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners’ caseload.'

The outcome of this study suggests that, in the circumstances of this study, nurses can be substituted for doctors and this could be useful where there is a shortage of doctors.  Specifically, the authors conclude: 'a GP can be substituted by an NP in a team with other GPs, just like in daytime primary care. The team with an NP provides care to the same number and type of patients. Consistent with what they learned in their master’s training programme, NPs saw a broad range of common complaints. Differences between the patients seen by NPs and GPs were mainly due to complaints that do not fit the predefined scope of NP care.'

You can listed to this as a podcast.

Reference

VAN DER BIEZEN M., SCHOONHOVEN L., WI JERS N., VAN DER BURGT R., WENSING M. & LAURANT M. (2016) Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental studyJournal of Advanced Nursing doi: 10.1111/jan.12954

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