Nursing Research and Practice / 2014 / Article / Tab 1

Review Article

A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?

Table 1

Summary of NP study characteristics.

Author, year, and country (additional publications)Study objective (number analyzed)ParticipantsIntervention(NP role)Number of sitesNumber of NPs
experience and training

NP in outpatient setting ()
Allen, 2002, US [38] (Paez and Allen, 2006) [87]Compare NP plus usual care () to usual care () in the management of blood lipids in patients with CHD228 adults with hypercholesterolemia and CHD who were hospitalized for CABG or PCINP counseled on lipid management and lifestyle changes and had permission to prescribe (complementary role) 11 NP
Education and experience were not reported

Dierick-van Daele, 2009, NL [39] (Dierick-van Daele et al., 2010) [88]Compare NP () and GP () in the provision of primary care 1501 patients attending a primary care appointment for common complaintsNP saw patients at first point of contact; a GP was required to sign off all prescriptions (alternative role) 1512 NPs
All completed a 2-year ANP MSc in previous 2 months

Kinnersley, 2000, UK [40]Compare NP () and GP () in the provision of primary care1465 (1368 analyzed) patients seeking a same-day appointmentNP saw patients at first point of contact; a GP was required to sign off all prescriptions (alternative role) 1010 NPs
All completed an NP diploma at least 1 year previously

Krein, 2004, US [41]Compare NP plus usual care () and usual care () in the management of type 2 diabetes246 adults with type 2 diabetes and poor glycemic controlNP followed the Chronic Care Model in helping patients to manage glucose levels; PCPs were required to approve medication changes (complementary role) 22 NPs
2-day training session; other education and experience were not reported

Limoges-Gonzalez, 2011, US [42]Compare gastroenterology NP () to gastroenterologists () in screening colonoscopies150 average risk patients ≥50 yrs who were referred for a screening colonoscopyNP performed the colonoscopy under the same conditions as medical doctors and polypectomies were performed by the NP independently (alternative role) 11 NP
Intensive training followed by 2 years of practice

Litaker, 2003, US [43]Compare NP plus usual care () and usual PCP care () in the management of patients with hypertension and diabetes157 adult patients with mild-moderate hypertension and NIDDM without end-organ complicationsNP saw patients at first point of contact and provided telephonic and in-office management; permission to prescribe was not reported (complementary role) 11 NP* 
Specific training for the management of diabetes and hypertension

Mundinger, 2000, US [44] (Lenz et al., 2002; Lenz et al., 2004) [89, 90]Compare NP () and physician () ongoing primary care1981 ED or urgent care adult patients with no regular source of careNP saw patients at first point of contact and had authority to prescribe (alternative role) 57 PTE NPs 
School of nursing faculty members with specialties in adult primary care

Nelson, 1991, US [45]Compare pediatric NP telephone support plus usual care () to usual care () of parents after an ED visit for their child’s acute illness190 (184 analyzed) outpatient children (<8 yrs) who attended the ED for an acute infectious or allergic conditionNP made telephone contact with parent(s) after discharge, provided education and treatment review, answered questions, and facilitated communication between family and PCP; permission to prescribe was not reported (complementary role) 22 NPs 
Education and experience were not reported

Schuttelaar, 2010, NL [46] (Schuttelaar et al., 2011) [91]Compare NP () and dermatologist () care of children with eczema160 children with atopic dermatitis who were newly referred by their GP or paediatricianNP provided the same services as the dermatologist and was able to prescribe independently (alternative role) 11 NP 
ANP masters prepared with 3-year experience in dermatology

Smith, 2006, US [47] (Lyles et al., 2003; Luo et al., 2007) [92, 93]Compare NP plus usual care () and usual care () in the management of patients with medically unexplained symptoms206 patients (18–65 years) with medically unexplained symptoms and high utilization of primary care servicesNP coordinated and managed care over a minimum of 12 scheduled visits over a year and telephone contact between visits (complementary role) 34 NPs 
Certified with 84 hours of special training, no prior experience in mental health

Venning, 2000, UK [48]Compare NP () and GP () primary care of patients seeking same day consultations1316 patients of all agesNP saw patients at first point of contact; a GP was required to sign off all prescriptions (alternative role) 2020 NPs 
Diploma, BSc, or MSc prepared with 1–5 years as an NP

NP in transition role ()
Coleman, 2006, US [49] (Parry et al., 2003) [94]Compare geriatric NP plus usual care () and usual care () of older patients with complex care needs750 chronically ill, community-dwelling, local, older adults (≥65 yrs) admitted to hospital for 1 of 11 nonpsychiatric conditionsNP met with patient in hospital and made a home visit and telephone calls after discharge; patients transferred to a skilled nursing facility were telephoned or visited at least weekly (complementary role) 102 NPs* 
Experienced geriatric NPs who were skilled in patient education and advocacy

Hollingsworth 2000, US [50]Compare NP-facilitated early discharge, follow-up care plus usual care () and usual care () of women who have had an abdominal hysterectomy113 women (≥21 yrs) undergoing abdominal hysterectomy for nononcologic indicationsNPs had contact with patient in hospital, encouraged early discharge, made home visits and telephone calls, and were available for patients and families by telephone (complementary role) 12 NPs (1 FTE and 1 PTE)
Masters prepared

Kotowycz, 2010, CAN [51]Compare NP-facilitated early discharge, follow-up care plus usual care () and usual care () of patients with low-risk STEMI54 low-risk (Zwolle Primary PCI Index ≤3) STEMI patients treated with primary or rescue PCI.NP saw patients before and after discharge and provided education and appointment reminders; permission to prescribe was not reported (complementary role) 11 NP* 
Education and experience were not reported

Nathan, 2006, UK [52]Compare respiratory specialist NP () and respiratory doctor () in the provision of follow-up care to acute asthma patients154 acute asthma patients (>16 yrs) discharged from hospital. Those with COPD were excluded.NP saw outpatients after discharge and for follow-up appointments; NP prescribed independently according to a patient group directive (alternative role) 11 NP 
Masters prepared with specialist training in acute asthma management

Rawl, 1998, US [53] (Easton et al., 1995) [95]Compare NP postdischarge follow-up plus usual care () and usual care () of rehabilitation patients with long-term disabilities100 rehabilitation patients (≥18 yrs), who were not confined to their homeNP contacted patients before discharge and in the rehabilitation clinic, in their home, and by telephone after discharge (complementary role) 11 NP 
Certified in rehabilitation, 10-year experience

NP in inpatient setting ()
Mitchell-DiCenso, 1996, CAN [54]Compare NP () and pediatric resident teams () in neonatal intensive care821 neonates admitted to the neonatal intensive care unit.NP team assumed primary responsibility for neonates (alternative role) 14.5 FTE NPs 
All graduates of a 16-month Masters program

Pioro, 2001, US [55]Compare NP () and house staff () in care of general medical patients381 adult general medical patientsNPs provided many of the same services delivered by traditional house staff (alternative role) 12.5 FTE NPs 
Experience and training were not described

ANP: advanced nurse practitioner; BSc: Bachelor of Science; CABG: coronary artery bypass surgery; CAN: Canada; CHD: coronary heart disease; COPD: chronic obstructive pulmonary disease; GP: general practitioner; ED: emergency department; FTE: full-time equivalent; MSc: Master of Science; NIDDM: non-insulin dependent diabetes mellitus; NL: The Netherlands; NP: nurse practitioner; PCI: percutaneous coronary intervention; PCP: primary care provider; PTE: part time equivalent; STEMI: ST-elevation myocardial infarction; UK: United Kingdom; US: United States.
*Data provided by author.