Nurse practitioners are an essential part of the health care team because of their training regarding diagnosis, order and interpretation of medical images and other diagnostic tests. Nurse practitioners are also qualified to prescribe medication and other therapeutic measures and to perform specific medical procedures (Donald, Martin-Misener, Carter, Donald, Kaasalainen, Wickson-Griffiths et al., 2013). Despite this variety of functions, nurse practitioners tend to have more time an a special set of skills available to better take care of patients, when compared to General Practitioners (Albers-Heitner, Lagro-Janssen, Joore, Berghmans, Nieman, Venema et al., 2011). Plus, some evidence indicates that, interventions led by nurse practitioners instead of medical doctors are both cost-saving and cost-effective (Schuttelaar, Vermeulen & Coenraads, 2011). Therefore, including nurse practitioners in the health team, or substituting doctors with nurse practitioners whenever possible might help alleviate scarce healthcare budgets, while providing the same degree of quality of care to patients. A systematic review is a useful way to identify, appraise, select and synthesize currently available high quality evidence in order to further explore these and other topics.
Statement of the Problem
Nurse practitioners are qualified to provide high-quality health care to patients of all ages suffering from both acute and chronic illnesses. It is hypothesized that nurse practitioners deliver health care by similar standards as their medical doctor counterparts, therefore being considered as effective as their medical peers (Dierick-van Daele, Steuten, Metsemakers, Derckx, Spreeuwenberg & Vrijhoef, 2010). Effective care is characterized by producing the intended result, and is a measure of quality (Stanik-Hutt, Newhouse, White, Johantgen, Bass, Zangaro et al., 2013). Within the health care context, effectiveness can be defined as higher quality of life, lower costs, less follow-up consultations and better clinical and laboratory outcomes for patients. However, the evidence currently available is still scarce and inconclusive. Therefore, the purpose of this study is to find out if patient care is in fact more effective when children or adult patients suffering from either acute or chronic diseases such as urinary incontinence, metabolic diseases or eczema are treated including nurse practitioners in the care team, as opposed to teams consisting only of medical doctors or lacking nurse practitioners. A systematic review will be carried out in order to answer this question.
Null hypothesis: There are no statistically significant differences in effectiveness of care provided by nurse practitioners when compared to medical doctors.
Alternative hypothesis: There are statistically significant differences in effectiveness of care provided by nurse practitioners when compared to medical doctors.
Effectiveness will be defined as higher quality of life, lower costs, less follow-up consultations and better clinical and laboratory outcomes for patients.
a) Presence of nurse practitioner in the health care team
Quality of Life
Health care costs
Follow up consultations
Clinical and laboratory outcomes: urinary incontinence, blood pressure, blood glucose, serum lipid levels, and eczema.
Operational definitions and operationalize variables
Albers‐Heitner, C. P., Lagro‐Janssen, A. L. M., Joore, M. A., Berghmans, L. C. M., Nieman, F., Venema, P. L., & Winkens, R. A. G. (2011). Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial. International journal of clinical practice, 65(6), 705-712. http://www.ncbi.nlm.nih.gov/m/pubmed/21564445/
Dierick-van Daele, A. T., Steuten, L. M., Metsemakers, J. F., Derckx, E. W., Spreeuwenberg, C., & Vrijhoef, H. J. (2010). Economic evaluation of nurse practitioners versus GPs in treating common conditions. British Journal of General Practice, 60(570), e28-e35. http://www.ncbi.nlm.nih.gov/m/pubmed/20040165/
Donald, F., Martin‐Misener, R., Carter, N., Donald, E. E., Kaasalainen, S., Wickson‐Griffiths, A., & DiCenso, A. (2013). A systematic review of the effectiveness of advanced practice nurses in long‐term care. Journal of advanced nursing, 69(10), 2148-2161. http://www.ncbi.nlm.nih.gov/m/pubmed/23527481
Higgins JPT, Green S (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Schuttelaar, M. L. A., Vermeulen, K. M., & Coenraads, P. J. (2011). Costs and cost‐effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs. British Journal of Dermatology, 165(3), 600-611. http://www.ncbi.nlm.nih.gov/m/pubmed/21692770/
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492-500. http://www.sciencedirect.com/science/article/pii/S1555415513004108