Advanced Practice Nurses as Primary Care Providers: a Systematic Review
Background: Full deployment of APNs presents one promising strategy to alleviate the increasing United States primary care shortage but research is needed to demonstrate safety and effectiveness of primary care provided by APNs.
Methods: Three databases were systematically searched to identify RCTs and their follow up reports that compared outcomes of care provided to adults by APNs and physicians in equivalent primary care provider roles.
Results: Ten studies (7 RCTs, 2 economic evaluations, and 1 two year follow-up study of an included RCT) were included in the systematic review. These studies represented data for 10,911 patients who presented for ongoing care (4 RCTs) or same-day consultations (3 RCTs) in the primary care setting. Study follow-up ranged from 1 day to 2 years. APN groups demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction, and cost. In healthcare resource utilization, APNs generally had longer consultations compared to physicians; however two studies reported that APN patients required fewer consultations over time.
Implications: There were few differences in primary care provided by APNs and physicians; for some measures APN care was reported to be superior. While studies are needed to assess longer term outcomes, these data suggest that the APN workforce is well-positioned to provide safe and effective primary care.