title: Impact of nurse practitioners on workload of general practitioners: randomised controlled trial.
abstract: OBJECTIVE
  To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team.
  
  
  METHODS
  Randomised controlled trial with measurements before and after the introduction of nurse practitioners.
  
  
  METHODS
  34 general practices in a southern region of the Netherlands.
  
  
  METHODS
  48 general practitioners.
  
  
  METHODS
  Five nurses were randomly allocated to general practitioners to undertake specific elements of care according to agreed guidelines. The control group received no nurse.
  
  
  METHODS
  Objective workload, derived from 28 day diaries, included the number of contacts per day for each of three conditions (chronic obstructive pulmonary disease or asthma, dementia, cancer), by type of consultation (in practice, telephone, home visit), and by time of day (surgery hours, out of hours). Subjective workload was measured by using a validated questionnaire. Outcomes were measured six months before and 18 months after the intervention.
  
  
  RESULTS
  The number of contacts during surgery hours increased in the intervention group compared with the control group (P < 0.06), particularly for patients with chronic obstructive pulmonary disease or asthma (P < 0.01). The number of consultations out of hours declined slightly in the intervention group compared with the control group, but this difference did not reach significance. No significant changes became apparent in subjective workload.
  
  
  CONCLUSIONS
  Adding nurse practitioners to general practice teams did not reduce the workload of general practitioners, at least in the short term. This implies that nurse practitioners are used as supplements, rather than substitutes, for care given by general practitioners.
authors.affiliation: Centre for Quality of Care Research (WOK), University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands. m.laurant@wok.umcn.nl
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
authors.forename: Rosella P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: Bonnie
authors.initials: B
authors.lastname: Sibbald
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D005194:Family Practice / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D009426:Netherlands; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*