Patient Satisfaction: Physicians VS.
Nurse Practitioners
Bailey Regier, Kylie Kuebler, Kathryn Birky, and Kyleigh Werner
PICo
Do patients in primary care settings prefer nurse practitioners to medical doctors in the United States?
Description of Search Process
Inclusion/Exclusion material:
Data base | Stratification OR Patient Preference | Primary care setting OR Clinics | Physians OR Nurse Practitioners | Effectiveness OR efficiency OR effective | |
Medline | 164,936 | 5,045 | 869 | 201 | Chose 2 out of 201 |
CINHAL | 46,000 | 694 | 139 | 39 | Chose 2 out of 39 |
PubMed | 17,4261 | 6,230 | 1,169 | 269 | Chose 1 out of 269 |
7,000,000 | 7,000,000 | 600,000 | 1,000,000 | Chose 6 out of 1,000,000 |
Extraction
Study 1:per APA: found via Ebscohost (CINHAL)
Iglesias, B., Ramos, F., Serrano, B., Fàbregas, M., Sánchez, C., García, M. J., & ... Esgueva, N. (2013). A randomized controlled trial of nurses vs. doctors in the resolution of acute disease of low complexity in primary care. Journal Of Advanced Nursing, 69(11), 2446-2457. doi:10.1111/jan.12120
Critical Appraisal 1
Study | Summary | Tool | Quality/Level |
STUDY 1: A randomized contol trial of nurses vs. doctors in the resolution of acute disease of low complexity in primary care | Results are BAE as indicated by trial CASP tool used. Study concluded that nurses had a higher number of patients with a resolution of symptoms as well as a higher percentage of patient satisfaction than MD’s. | Trial CASP | Level 1.a Systematic review of Randomized Controlled Trials (RCTs) |
Extraction
Study 2: per APA: found Via Ebscohost (CINHAL)
Abraham, J., Sick, B., Anderson, J., Berg, A., Dehmer, C., & Tufano, A. (2011). Selecting a provider: what factors influence patients' decision making?. Journal Of Healthcare Management / American College Of Healthcare Executives, 56(2), 99-114.
Critical appraisal 2
Study | Summary | Tool | Quality/Level |
STUDY 2: Selecting a provider: What factors influence patients’ decision making? | Results are BAE as evidenced by critical Appraisal of a Survey CASP tool. Study concluded that few consumers are aware of formal sources of provider information and even fewer base their decisions on it. | Survey CASP | Level 4.b Cross Sectional Study |
Extraction
Study 3:per APA: found via Ebscohost (CINHAL)
Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ: British Medical Journal (International Edition), 324(7341), 819-823. doi:10.1136/bmj.324.7341.819
Critical Appraisal 3
Study | Summary | Tool | Quality/Level |
Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. | Results are BAE as evidenced by critical Appraisal of a Systematic Review CASP Tool. Patients were more satisfied with care by a nurse practitioner. No differences in health status were found. Nurse practitioners had longer consultations and made more investigations. Quality of care was in some ways better for nurse practitioner consultations. | Systematic Review CASP Tool | Level 1.b: Systematic review of RCTs and other study designs |
Extraction
Study 4: per APA: found Via PubMed
Roots, A., & MacDonald, M. (2014). Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study. Human Resources For Health, 1269. doi:10.1186/1478-4491-12-69
Critical Appraisal 4
Study | Summary | Tool | Quality/Level |
Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study. | Results are BAE as evidenced by critical Appraisal of a Case Control Study Tool. The results showed that NPs affected how care was delivered, through the additional time afforded each patient visit and development of a team approach with interprofessional collaboration. Patient access to the practice improved with increased availability of appointments. Access to primary care improved for harder-to-serve populations and new linkages developed between the practice and their community. | Case Control Study Tool | Level 4.d – Case study |
Extraction
Study 5: per APA: found via Ebscohost (CINHAL)
Foreman, D.M., Morton, S. (2010). Nurse-delivered and doctor-delivered care in an attention deficit hyperactivity disorder follow-up clinic: a comparative study using propensity score matching. Journal of Advanced Nursing 67(6), 1341-1348. doi:10.1111/j.1365.2648.2010.05602.x
Critical Appraisal 5
Study | Summary | Tool | Quality/Level |
STUDY 5: Nurse-delivered and doctor-delivered care in an attention deficit hyperactivity disorder follow-up clinic: a comparative study using propensity score matching | Results are BAE as evidenced by Appraisal of Randomized Control Trial CASP tool. Study concluded that there is no significant difference between the care provided by doctors and nurse practitioners. Data was gathered via questionnaires. | Randomized Control Trial CASP | Level 2.C Quasi-Experimental prospectively controlled study |
Justification for bae
For an article to be best evidence, it must be valid, useful, and generalizable.The articles above provide best available evidence because they entail these qualities and three of them are within Level 1 and Level 2. These are the highest forms of evidence. Four out of the five articles were published within the last seven years. All were peer-reviewed and from credible databases. Using Boolean terms greatly narrowed the articles in the databases used and made the articles more specific.After analysing each article with a CASP tool, we have come to the conclusion that the articles within this slide should be used to research if patients prefer medical doctors or nurse practitioners in primary care within the United States.
summary
The implications for nursing practice include understanding that NPs are capable of providing quality care to their clients. NPs spend more time on average with their clients, and therefore, more time investigating symptoms. Evidence shows that patients prefer this aspect. However, evidence shows that quality care is administered by both NPs and MDs. Nurses, using the best available evidence, can advocate equal care for their clients in the form of treatment from either an NP or an MD.
The answer to the PICo as stated is “no”, while some individuals do prefer an NP over an MD, not all do.