title: Evaluation of initial implementation of an organized adult health program employing family nurse practitioners.
abstract: An organized program for periodic health evaluation of adults was instituted at one Group Health Cooperative Clinic (A) using a fixed exam schedule and two family nurse practitioners (FNPs), working in a team with six family practitioners, to perform as many of the examinations as possible. We evaluated the effects of the FNP program at Clinic A in terms of six specific objectives, comparing it with the preexisting conventional pattern in another clinic (B). The evaluation showed 1) diminished waiting times at Clinic A; 2) no diminution in quality of examinations performed by FNPs; 3) lesser unit costs in Clinic A; 4) no indication of higher overall postexam outpatient utilization or costs for those examined by FNPs; 5) greater patient satisfaction at Clinic A than Clinic B, and for those examined by FNPs, compared with those examined by physicians (MDs); 6) only 17 per cent of FNP time was spent on health evaluations and met one half the overall demand at Clinic A; 7) FNPs made day-to-day practice qualitatively more complex for some MDs; and 8) different staffing ratios are probably necessary when FNPs are teamed with family physicians rather than internists.
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010808:Physical Examination; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000458:organization & administration*; D014861:Washington