Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review.

IF 3.2 3区医学 Q1 NURSING

Journal of Clinical Nursing Pub Date : 2024-12-09 DOI:10.1111/jocn.17614

Madison Horton, Justinna Dixon, Eleanor Turi, Chinmayi Balusu, Rachel Paikoff, Claudia B Maier, Lusine Poghosyan

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引用次数: 0

Abstract

Aim: Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.

Design: Scoping review.

Methods: A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist.

Data sources: PubMed, CINHAL and Embase for articles between 2016 and 2023.

Results: Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management.

Conclusion: Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.

Implications for the profession and/or patient care: Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care.

Impact: Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.

Patient or public contribution: No patient or public contribution is required for this study.

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初级保健高级执业护士及其对全球卫生服务利用、成本和获取的影响：范围审查。

目的：综合证据先进的实践护士对卫生服务的利用，医疗保健成本，获得和护理质量的影响全球。设计：范围审查。方法：以乔安娜布里格斯研究所证据综合手册和PRISMA-ScR检查表为指导进行范围审查。数据来源：PubMed， CINHAL和Embase， 2016 - 2023年的文章。结果：纳入了18项研究（14项来自美国，2项来自荷兰，澳大利亚和新西兰各1项）。结果包括卫生服务利用率、卫生保健费用、可及性和护理质量。大多数研究报告了高级实践护理患者较少急诊科（11项研究中的9项），较少住院（再）入院（10项研究中的9项）和初级保健就诊（3项研究中的3项）。七（八）项研究发现，高级护理实践与显著降低医疗成本有关。在获取和护理质量方面，高级实践护理与较低的咨询率、相似的平均就诊人数、较高的方案依从性、更多的农村患者护理和较低至相似的慢性疾病管理质量相关。结论：大多数研究报告，高级实践护理与较低的急诊科就诊、再入院率和费用有关。在高级护理实践中，获得护理结果的机会各不相同。对专业和/或患者护理的影响：高级护理实践可以改善患者的治疗效果，降低成本，影响护理的可及性和质量。实践需要支持性的工作环境，为高级实践护士提供高质量，有效的护理。影响：考虑到对最新证据的综合需要，本综述强调了初级保健中高级实践护士的重要性。研究结果可以为全球劳动力发展战略提供信息，通过有效的高级护理实践整合来解决健康不平等问题。患者或公众贡献：本研究不需要患者或公众贡献。

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来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.