Literature Review on "Patient Outcomes Affected by Using Nurse Practitioners"

Literature Review 20 pages (6797 words) Sources: 25

[EXCERPT] . . . .

The analysis of univariate multi-level regression (cut off p? 0.15) displayed the level of satisfaction associated with the NPs was linked with the frequent contact with them and the general practitioner's score of satisfaction of the job. This previously had only been associated with the NPs in the previous 6 months and was linked with high satisfaction with the NPs (Laurant et al., 2008).

As the amount of contacts with the NPs increased, so did the level of satisfaction (0.05; 95% CI, 0.001 -- 0.10). A total variance of 4.3% was explained by this characteristic. The level of satisfaction associated with the general practitioners was linked with the frequent contacts with them, self-reported health, and gender as shown by univariate multilevel linear regression (cut off p?0.15). The multi-variate, multi-level regression showed the link between poor self reported health and the high level of satisfaction. The sicker the patient got, the more the satisfaction increased (0.36; 95% CI, 0.05 -- 0.66). The total variance was shown to be 3.4%. Other than this, no other traits of NPs, GPs or patient were linked with the score of satisfaction. Both the GPs' and the NPs' score difference was shown between each patient which is 85 to 90% while only 10 to 15% of the difference was displayed by the NPs and the GPs (Laurant et al., 2008).

Clinical Outcomes Research

The outcomes of research addressing the role of the nurse practitioners has been satisfactory and complete as compared to the physicians; most of the patients are satisfied by the work of NPs. Horrocks, Anderson, and Salisbury (2002) in their study stated no difference in the cost and health status of the NPs and the physicians by reviewing and analyzing 23 studies of observation and eleven trials, based on the results of the patient's care process, health status and satisfaction. However, the five topics which showed the satisfaction of the patient as the data of outcome showed statistical and important variations between the satisfaction of the patient, and the satisfaction of the work between the NPs and the physicians. The investigation displayed that the longer the hours of consultation by the NPs, the higher the score of satisfaction went. The study by Mundinger et al. (2000) also stated that no statistical or important difference were found in the health status, satisfaction of the patient, or the results between the physician and NP- delivered services of health care. Different factors like high satisfaction among the patients, low rates of prescription, results and utilization of diagnostic tests, and safe outcomes of clinics has also been conducted (Agosta, 2009).

The study of the roles of NPs and satisfaction of the patients in diverse and varied systems of health care is an important challenge for the current advancements and evolution in the profession of nurse practitioners. As the comparable outcomes between the nurse practitioners and the physicians has been established, demand for more concentrated and focused areas of investigation related to the nurse practitioners' satisfaction has come forward as important and needed for the field. This research investigates and analyzes the model of nurse practitioners' delivered model of primary care in the professional setting (Agosta, 2009).

Different researchers that have measured the variations in outcomes of patient care have stated that the care provided by the NPs and the physicians is equal and not different to each other. In Canada in 1974, one of the first NP trials was conducted by Burlington. This explored and demonstrated the safety and effectiveness of the care that was being delivered by the NPs. The comparison of NPs and physicians was demonstrated based on the outcomes of safety and effectiveness of the services provided, clinic effectiveness, emotional, and physical function and motality. Some of the recommendations for further research suggested an exam to identify and delineate the unique and specific characteristics of the NPs (Sackett et al., 1974).

Around 248 papers were reviewed in a systematic manner. These discussed NPs and showed clinical outcomes and satisfaction to be either greater or equal to that found when compared to the physicians (Feldman, Ventura, & Crosby, 1987). Horrocks et al. (2002) stated that there was no difference between the costs and the health status when comparing the NPs and the physicians by reviewing 23 studies through observations and 11 trials based on the results of the care process, cost, health status, and satisfaction of the patient. The studies that were analyzed were the ones which compared the physicians and the nurse practitioners in the same settings of the clinic. In one of the 5 studies that showed the satisfaction of the patients, a significant amount of difference was seen between the NPs and the physicians. The other two researches which showed the results of patient satisfaction as dichotomous data showed no statistical importance and difference between the two providers. Other studies that were included showed the improvement in satisfaction level with the increased amount of consultation with the NPs (Agosta, 2005).

Another study analyzed the health care which was either received from the physicians of the nurse practitioners in general medical practice. The sample of the study included 1368 patients who were going for similar day visits of health care and were randomly sent to either the physicians of the NPs. The main variables that were examined were the satisfaction of the patient and the resolution of the symptom in the next visit after two weeks. The other outcomes were appointment reschedule as seen through the intention of the patient, consultation of follow-up, and the perception of the patient during the checkup. The patients gave their responses through a survey questionnaire right after their first visit and the following second visit after two weeks. The results of the questionnaire stated that the patients of NPs got long hours of consultations as compared to the physicians, but there was not difference in the outcome of the clinic (Agosta, 2005).

More conclusions that came forward was the complete satisfaction of the patients with the health care that they had received from the NPs. Mundinger et al. (2000) in a well publicized lay and medical article stated that there was no importance difference found in the outcome, satisfaction of the patient, or the health status of the patient between the health care provided by the physician or the NPs. This study included 1316 patients randomized to the group of NP or the physician based on four community clinics and one urban clinic. The satisfaction of the patients was calculated by a survey of fifteen questions which were conducted after the first visit and then after the second visit after six months. Additionally, the Medical Outcome Study Short Form 36 was used to analyze the physiological status throughout the two intervals of assessment. The researchers stated the outcome of satisfaction of patient and equality in care given by the physicians and the NPs that was supported strongly by the statistical analysis from the study's data (Agosta, 2005).

There was no important difference seen in the satisfaction of the patient of the health status either in the first visit or in the second visit after six months. An article by Sox (2000) in response to the study by Mundinger et al. (2000) said that the results of the research providing the same results between the physician and the NPs provided a doubt to the external validity of the research. The article also questioned the validity and the generalization of the study between NPs and the physicians, and also showed doubt in the indicators that were used in testing the six-month interval between the visits. It was stated by Sox (2000) that the sample of the research contained 76% females with 44 as an average age caused questions as to the validity of the work. However, he did not concede the fact that the study was done using sound methodology, which lists an outcome of a powerful interval validation. Sox (2000) accepted the study's outcome of generalization when it came to the short-term outcomes and service delivery; he also stated that generalizing them for long-term would require caution. Mundinger et al. (2000) also gave an outcome of the two-year follow up; that too validated no statistically important difference in the visits to the emergency room, referrals of the specialists, disease pathology, satisfaction and health status between the clients of NPs and the physicians' (Agosta, 2005)

A study by Kinnersley et al. (2000) examined the practicability of the NPs in an emphasized role by studying 286 patients for two years who were randomly assigned to either the physician or the NPs group for similar day appointments of the clinic. The research took into consideration different factors over the period of two years. The perception and satisfaction of the patients were analyzed right after the visit through the interviews. Thirty patients were additionally chosen for the interview after the follow-ups, regarding… READ MORE

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