Deshefy-Longhi Terry, Swartz Martha K, Grey Margaret
Yale University School of Nursing, Hamden, Connecticut 06536-0740, USA.
J Am Acad Nurse Pract. 2008 May;20(5):281-7. doi: 10.1111/j.1745-7599.2008.00318.x.
The purpose of this study was to characterize nurse practitioners' (NPs') practice by using reports of patient encounters to more accurately reflect practice patterns than has been previously performed. This study was part of a larger primary care practice survey by a consortium of 20 practice-based research networks (PBRNs). Therefore, comparisons, when appropriate, were also made between this network of NPs (Advanced Practice Registered Nurse Network, APRNet) and the other 19 physician-run research networks.
A descriptive survey was developed by the 20 PBRN consortium under grants from the Agency for Healthcare Research and Quality. The consortium's goal was to collect primary care data over a 6-month period and to document and compare primary care practice in the United States. The data were collected immediately following members' encounters with patients rather than from billing spreadsheets. Nineteen PBRNs may have had NPs in the practices that comprised their networks. However, the data from these NPs were collected under the study ID numbers of the physician owners of each practice. APRNet, therefore, was the sole research network comprised exclusively of NPs who collected and reported data under their own study ID numbers.
Acute health problems comprised 45% of all episodes treated by NPs compared to 30% of episodes for exacerbations of chronic conditions and 24.5% for nonillness and health promotion visits. In addition, our findings suggest that NPs provide counseling in 84% (vs. 61% for physicians) of their primary care visits, regardless of the reason for visit, and the type of counseling varies by the type of NP.
Despite many studies on the comparability and outcomes of NP practice, the need to identify, clarify, and document the practices of NPs in primary care settings remains. The present survey provides an important and useful first step in providing a systematic way to characterize these practices through a survey of APRNs immediately following their patient encounters.
本研究的目的是通过使用患者诊疗报告来描述执业护士（NP）的执业情况，以便比以往更准确地反映执业模式。本研究是由20个基于实践的研究网络（PBRN）组成的联盟开展的一项更大规模的初级保健实践调查的一部分。因此，在适当的时候，还对这个NP网络（高级实践注册护士网络，APRNet）与其他19个由医生主导的研究网络进行了比较。
20个PBRN联盟在医疗保健研究与质量局的资助下开展了一项描述性调查。该联盟的目标是在6个月的时间内收集初级保健数据，并记录和比较美国的初级保健实践。数据是在成员与患者诊疗后立即收集的，而不是从计费电子表格中收集。19个PBRN的网络实践中可能有NP。然而，这些NP的数据是根据每个实践的医生所有者的研究识别号收集的。因此，APRNet是唯一完全由NP组成的研究网络，这些NP以自己的研究识别号收集和报告数据。
NP治疗的所有病例中，急性健康问题占45%，相比之下，慢性病加重病例占30%，非疾病和健康促进诊疗占24.5%。此外，我们的研究结果表明，无论就诊原因如何，NP在其84%的初级保健诊疗中提供咨询服务（医生为61%），并且咨询类型因NP类型而异。
尽管对NP实践的可比性和结果进行了许多研究，但在初级保健环境中识别、澄清和记录NP的实践仍然很有必要。本次调查通过在APRN与患者诊疗后立即进行调查，为系统描述这些实践提供了重要且有用的第一步。
