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.
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.
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.
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.
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.