So I was just reading this article by NCBI:
Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses - VA Evidence-based Synthesis Program Evidence Briefs - NCBI Bookshelf
And here is one important quote I will say from it and
I will bold the reason why it doesn't really seem valid or fair - Also this article is from 2014. Also, I will say that this study is almost silly because the patient's were being discharged from an ED or UC where their problem was treated - they just needed very slight probably symptomatic treatment or simply prescribing what the ED had offered or suggested. An ED f/u pt typically brings their discharge forms with them from the ED.
"Primary Care. A randomized controlled trial by Mundinger and colleagues is the best available evidence regarding the effectiveness of independent primary care NPs in the primary care setting.
53 Patients recruited from an urgent care center and 2 emergency rooms were randomly assigned to a provider in a clinic staffed exclusively by NPs or to a clinic staffed by physicians (
Table 1).
53 There was no difference between the nurse practitioner group and the physician group in physical or mental Medical Outcomes Study Short-Form Health Survey (SF-36) scores for the 79% of enrolled patients who completed the 6-month follow-up interview (physical component summary scores (adjusted for age, sex, baseline scores, and selected chronic conditions): NP group: 40.53; physician group: 40.60;
P=0.92).
Table 1
Effect of care by an APRN on health status.
Strengths of this large study (1,316 patients, 7 NPs, 11 physicians) were that NP and MD practices were not co-located and practitioners were not necessarily aware of patient's involvement in the study. Patients were also new to both groups of providers and NPs had the same authority as MDs to prescribe, consult, refer, and admit patients.
The main weakness of the study was that 6 months is not an adequate follow-up time for the outcome of health status. The care provided in 6 months was too short to represent continuity care. Within the 6-month follow-up period, for example, 42% of patients had 0 or 1 primary care visits. As Sox noted in an editorial that accompanied the trial, “The short duration of the trial limits its ability to test a health professional's competence across the broad spectrum of primary health care.”
60 After 2 years, researchers were able to contact 66% of the enrolled patients, and 55% of them had returned to their originally assigned provider.
52 In this subsample, there were differences in NP-assigned patients (n=222) and the physician-assigned patients (N=184) in the proportion of Hispanics (94.5 vs 89.6%), Medicaid enrollees (87.4 vs 95.7%) and other characteristics, so that
the benefits of randomization had been lost. Another weakness is that the data, which were collected between 1995 and 1997,
are now over 20 years old."
The discussion goes on to say:
"This evidence brief found that evidence regarding 4 important outcomes of patients cared for by a nurse working autonomously is inconclusive. Other systematic reviews have noted the small body of evidence regarding health outcomes of patients receiving care from an APRN or physician.
37,
41,
61
The studies we reviewed did not demonstrate a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations.
However, these studies were not large enough, and did not follow patients long enough, to exclude a possible difference."
