初级保健中的高级执业护士及其对全球卫生服务利用、成本和可及性的影响：一项范围综述
Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review.
作者信息
Horton Madison, Dixon Justinna, Turi Eleanor, Balusu Chinmayi, Paikoff Rachel, Maier Claudia B, Poghosyan Lusine
机构信息
T32 Predoctoral Trainee, Columbia University School of Nursing, New York, New York, USA.
National Clinician Scholars Program & Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
J Clin Nurs. 2025 May;34(5):1592-1601. doi: 10.1111/jocn.17614. Epub 2024 Dec 9.
AIM
Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.
DESIGN
Scoping review.
METHODS
A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist.
DATA SOURCES
PubMed, CINHAL and Embase for articles between 2016 and 2023.
RESULTS
Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management.
CONCLUSION
Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care.
IMPACT
Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution is required for this study.
目的
综合全球范围内高级实践护士对卫生服务利用、医疗保健成本、医疗可及性和护理质量影响的证据。
设计
范围综述。
方法
采用乔安娜·布里格斯循证综合手册和PRISMA-ScR清单指导的范围综述。
数据来源
2016年至2023年期间在PubMed、CINHAL和Embase数据库检索文章。
结果
纳入18项研究（14项来自美国，两项来自荷兰，各有一项分别来自澳大利亚和新西兰）。结果包括卫生服务利用、医疗保健成本、医疗可及性和护理质量。大多数研究报告称，接受高级实践护理的患者急诊就诊次数较少（11项研究中的9项）、医院再入院次数较少（10项研究中的9项）以及初级保健就诊次数较少（3项研究中的3项）。八项研究中的七项发现，高级实践护理与显著降低的医疗保健成本相关。在医疗可及性和护理质量方面，高级实践护理与较低的会诊率、相似的平均就诊患者数量、更高的方案依从性、更多的农村患者护理以及慢性病管理的较低至相似质量提供相关。
结论
大多数研究报告称，高级实践护理与较少的急诊就诊、医院再入院和成本相关。在高级实践护理下，医疗可及性结果各不相同。
对该专业和/或患者护理的启示：高级实践护理可改善患者结局、降低成本并影响医疗可及性和护理质量。医疗机构需要为高级实践护士提供支持性工作环境，以提供高质量、有效的护理。
影响
本综述满足了对最新证据综合的需求，强调了高级实践护士在初级保健中的重要性。研究结果可为全球劳动力发展战略提供信息，通过有效整合高级实践护理来解决健康不平等问题。
患者或公众参与
本研究无需患者或公众参与。
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