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      Nurse practitioner-physician co-management of primary care patients: The promise of a new delivery care model to improve quality of care

      research-article
      , MSN, MPhil, ANP-BC, RN, , RN, FNP-BC, , RN, FNP-BC, , MSN, MPhil, RN, , PhD, MPH, RN, FAAN
      Health care management review
      Teamwork, Primary Care, Nurse Practitioners, Systematic Review, Co-Management

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          Abstract

          Background

          The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse Practitioner (NP)-physician co-management of primary care patients has been proposed by some policymakers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP-physician co-management in primary care.

          Purpose

          This is the first review to synthesize all available studies that compare the effects of NP-physician co-management to an individual physician managing primary care.

          Methods

          The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed and inclusion/exclusion criteria applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black’s quality checklist for randomized and nonrandomized studies.

          Results

          Six studies were identified for synthesis. Three outcome categories emerged: 1) PCP adherence to recommended care guidelines; 2) empirical changes in clinical patient outcomes; and 3) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP-physician co-management. There was variability of clinical patient outcomes with some findings favoring the co-management model. Limited differences in patient quality of life were found. Across all studies, the NP-physician co-management care delivery model was determined to produce no detrimental effect on measured outcomes, and in some cases, was more beneficial in reaching practice and clinical targets.

          Practice Implications

          The use of NP-physician co-management of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP-physician interactions and processes to isolate the attributes of a successful NP-physician co-management model.

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          Author and article information

          Contributors
          Journal
          7611530
          3962
          Health Care Manage Rev
          Health Care Manage Rev
          Health care management review
          0361-6274
          1550-5030
          18 March 2017
          Jul-Sep 2019
          01 July 2020
          : 44
          : 3
          : 235-245
          Affiliations
          PhD Candidate-Center for Health Policy; Columbia University School of Nursing
          DNP Candidate-Columbia University School of Nursing
          DNP Candidate-Columbia University School of Nursing
          PhD Candidate-Columbia University School of Nursing
          Assistant Professor-Columbia University School of Nursing
          Author notes
          Corresponding Author: Allison A. Norful MSN, MPhil RN, ANP-BC, Columbia University School of Nursing, 617 W. 168th Street, GB 239, New York, NY 10032, Mobile: 516-477-9444, Fax: 212-305-6937, aan2139@ 123456cumc.columbia.edu
          Article
          PMC5656564 PMC5656564 5656564 nihpa855387
          10.1097/HMR.0000000000000161
          5656564
          28445324
          516acb34-290e-4ad7-b216-4217b33045ea
          History
          Categories
          Article

          Systematic Review,Teamwork,Primary Care,Nurse Practitioners,Co-Management

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