Allison Andreno Norful, MSN, MPhil, ANP-BC, RN, is PhD Candidate, Center for Health Policy, Columbia University School of Nursing, New York, New York. E-mail:
Health Care Manage Rev. 2019 Jul/Sep;44(3):235-245. doi: 10.1097/HMR.0000000000000161.
The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse practitioner (NP)-physician comanagement of primary care patients has been proposed by some policy makers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP-physician comanagement in primary care.
This is the first review to synthesize all available studies that compare the effects of NP-physician comanagement to an individual physician managing primary care.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed, and inclusion/exclusion criteria were applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black's quality checklist for randomized and nonrandomized studies.
Six studies were identified for synthesis. Three outcome categories emerged: (a) primary care provider adherence to recommended care guidelines, (b) empirical changes in clinical patient outcomes, and (c) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP-physician comanagement. There was variability of clinical patient outcomes with some findings favoring the comanagement model. Limited differences in patient quality of life were found. Across all studies, the NP-physician comanagementcare delivery model was determined to produce no detrimental effect on measured outcomes and, in some cases, was more beneficial in reaching practice and clinical targets.
The use of NP-physician comanagement of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP-physician interactions and processes to isolate the attributes of a successful NP-physician comanagement model.
美国初级保健系统承受着巨大的压力，需要为数量不断增加的患者提供护理，而初级保健医生的短缺问题也同时存在。一些政策制定者提出，由执业护士（NP）与初级保健医生共同管理初级保健患者，以帮助缓解这种压力。迄今为止，尚无综合证据表明 NP-医生共同管理在初级保健中的效果。
这是第一项对比较 NP-医生共同管理与单个医生管理初级保健的所有现有研究进行综合的综述。
PRISMA（系统评价和荟萃分析的首选报告项目）框架指导了这项系统综述的进行。检索了五个电子数据库。对标题、摘要和全文进行了审查，并应用纳入/排除标准来缩小搜索结果，以确定符合条件的研究。使用 Downs 和 Black 的随机和非随机研究质量检查表对质量进行评估。
有 6 项研究被纳入综合分析。出现了三个结果类别：（a）初级保健提供者对推荐护理指南的遵守情况，（b）临床患者结果的实际变化，以及（c）患者/照顾者的生活质量。NP-医生共同管理完成的推荐护理指南明显更多。临床患者结果存在差异，有些发现有利于共同管理模式。患者生活质量的差异有限。在所有研究中，NP-医生共同管理的护理提供模式被确定为对测量结果没有不利影响，在某些情况下，在达到实践和临床目标方面更为有益。
鉴于患者群体规模不断增加和初级保健医生短缺的当前需求，使用 NP-医生共同管理初级保健患者是一种有前途的护理提供模式，可以提高护理提供的质量，并缓解组织压力。未来的研究应侧重于 NP-医生的相互作用和流程，以分离成功的 NP-医生共同管理模式的属性。
