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 Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care. 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.

An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review

“…Studies were conducted in 13 countries. The majority ( n = 11) were carried out in the United States of America (Buerhaus et al, 2018; Christiansen et al, 2016; Coddington et al, 2011; Farford et al, 2021; Jennings et al, 2016; Kinder, 2016; Kurtzman & Barnow, 2017; Mitchell et al, 2019; Poghosyan et al, 2018; Reuben et al, 2013; Wenger et al, 2011); four studies in the United Kingdom (Faulkner et al, 2016; Harris et al, 2015; Hawthorne et al, 2012; Stenner et al, 2011); three studies were Australian (Iles et al, 2014; Karnon et al, 2013; McCullough et al, 2020); three studies were undertaken in Canada (Dufour et al, 2020; Kosteniuk et al, 2017; Lawson et al, 2012); three in South Africa (Rabie et al, 2016; Rawat et al, 2018; Webb et al, 2019); and one in India (Fischer et al, 2015), Slovenia (Klemenc‐Ketis & Poplas‐Susič, 2017), The Netherlands (Vestjens et al, 2019), Sweden (Abrahamsson et al, 2015), Rwanda (Vasan et al, 2013), Argentina (Prestes et al, 2017), New Zealand (Azariah et al, 2013), and Switzerland (Gysin et al, 2020).…”

“…The majority of the studies ( n = 17) evaluated nursing PHC services operating within traditional physician‐led primary care community settings such as the General Practitioner clinic and other medical centers of care (Azariah et al, 2013; Buerhaus et al, 2018; Farford et al, 2021; Faulkner et al, 2016; Gysin et al, 2020; Harris et al, 2015; Hawthorne et al, 2012; Iles et al, 2014; Jennings et al, 2016; Karnon et al, 2013; Klemenc‐Ketis & Poplas‐Susič, 2017; Lawson et al, 2012; Mitchell et al, 2019; Poghosyan et al, 2018; Prestes et al, 2017; Reuben et al, 2013; Stenner et al, 2011). Fifteen studies were set in PHC settings such as remote community nursing services and urban community health centers and home visits (Abrahamsson et al, 2015; Christiansen et al, 2016; Coddington et al, 2011; Dufour et al, 2020; Fischer et al, 2015; Kosteniuk et al, 2017; Kinder, 2016; Kurtzman & Barnow, 2017; McCullough et al, 2020; Rabie et al, 2016; Rawat et al, 2018; Vasan et al, 2013; Vestjens et al, 2019; Webb et al, 2019; Wenger et al, 2011).…”

“…More commonly, evaluated PHC services included the nurse as a member of the multidisciplinary team. Often, studies aimed to evaluate nursing care by making comparisons between the care provided by nurses and that of other health professionals, most commonly a comparison between nurse practitioners and physicians (Buerhaus et al, 2018; Christiansen et al, 2016; Gysin et al, 2020; Iles et al, 2014; Jennings et al, 2016; Karnon et al, 2013; Klemenc‐Ketis & Poplas‐Susič, 2017; Kurtzman & Barnow, 2017; Lawson et al, 2012; Mitchell et al, 2019; Prestes et al, 2017; Reuben et al, 2013; Vestjens et al, 2019; Wenger et al, 2011).…”

“…For example, Buerhaus et al (2018) considered admission‐readmission rates, and appropriate use of clinical investigations in chronic disease management, whereas Mitchell et al (2019) focused on affordability of care and the care‐team's work life balance with family, pediatric, and community medicine patients. Quality service decisions were also evaluated; these included appropriateness of diagnostic tests ordered and medications prescribed and diagnosis accuracy (Gysin et al, 2020; Lawson et al, 2012; Vasan et al, 2013).…”

Clinical leadership in nursing students: A concept analysis

“…To address nursing leadership in the United States (US), the Clinical Nurse Lead role (CNL) was introduced in 2007, to meet higher standards of quality care provision (Clavo-Hall et al, 2018). Similar roles, that have a clear leadership remit such as nurse consultant and nurse practitioner have been developed elsewhere (Mullen et al, 2011;Josi & Bianchi, 2019;Gysin et al, 2020). Such roles do not directly address the pre-registration requirement for effective leadership.Despite there being no definition of clinical leadership in nursing students, there is a clear expectation that preparation for a leadership role is part of pre-registration preparation (Nursing and Midwifery Council, (NMC) 2019; Nursing and Midwifery Board of Ireland (NMBI), 2016; WHO, 2020).…”