ObjectiveTo determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care.DesignA systematic review of randomised controlled trials reported since 1980.Data sources10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites.Included studiesRandomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes.Results11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly.ConclusionsNurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.

Interpretive phenomenology presents a unique methodology for inquiring into lived experience, yet few scholarly articles provide methodological guidelines for researchers, and many studies lack coherence with the methodology’s philosophical foundations. This article contributes to filling these gaps in qualitative research by examining the following question: What are the key methodological and philosophical considerations of leading an interpretive phenomenological study? An exploration of interpretive phenomenology’s foundations, including Heideggerian philosophy and Benner’s applications in health care, will show how the philosophical tradition can guide research methodology. The interpretive phenomenological concepts of Dasein, lived experience, existentialia, authenticity are at the core of the discussion while relevant methodological concerns include research paradigm, researcher’s stance, objective and research question, sampling and recruitment, data collection, and data analysis. A study of pediatric intensive care unit nurses’ lived experience of a major hospital transformation project will illustrate these research considerations. This methodological article is innovative in that it explicitly describes the ties between the operational elements of an interpretive phenomenological study and the philosophical tradition. This endeavor is particularly warranted, as the essence of phenomenology is to bring to light what is taken for granted, and yet phenomenological research paradoxically makes frequent assumptions concerning the philosophical underpinnings.

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