Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

Abstract

Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in order to appraise whether the NP role meets the political and demographic demands in Swiss primary care.Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results Data from 5,210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1,613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70-4.36), multimorbid (OR 1.37; 95%-CI 1.24-1.51; p <0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15-1.42; p <0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72-3.42; p <0.001) and anthropometric data (OR 1.33; 95%-CI 1.09-1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04-1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30-0.41; p <0.001) were prescribed or changed less frequently in NP consultations. Conclusions NPs could offer care to the growing number of multimorbid, polypharmaceutical elderly, and might relieve work pressure from the GPs. Hence, the NP role has the potential to meet the current political and demographic demands in Swiss primary care. An extended scope of practice, especially prescription rights, could foster further professional practice and role implementation.