title: The value of nurse practitioners in Dutch general practices.
abstract: BACKGROUND
  Healthcare systems are faced with a changing and increasing demand for care. Against the background of the need to increase service capacity and to improve access to primary care, a project was initiated to introduce the nurse practitioner (NP) role into Dutch general practices.
  
  
  OBJECTIVE
  To explore the value of the NP by describing NP roles and their concordance with the initial concepts of the NP training programme.
  
  
  METHODS
  An observational longitudinal design, using mixed methods, was conducted between March 2004 and June 2008. A convenience sample of seven NPs and seven teaching general practitioners (GPs), together constituting seven experimental groups, was used. Project documentation and data from consultations between NPs and GPs were collected. Twenty-nine interviews were performed, focusing on NP roles, competencies of NPs and collaboration between professionals.
  
  
  RESULTS
  As was anticipated, all NPs have patients with common complaints as their main focus, as well as managing the quality of care projects. Differences between NPs are reported in the percentages of time spent in performing home visits, caring for older people, patient related activities and non-patient related activities.
  
  
  CONCLUSIONS
  NPs contribute to the accessibility and availability of primary care as well as to collaboration in and quality of primary care. The roles they adopt are influenced by practice needs and financial incentives. It is not clear to what degree NPs have to perform activities to improve quality of care and further research is necessary to define NP core competencies.
authors.affiliation: Department of Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands. angeliquedierick@orange.nl
authors.forename: Angelique T M
authors.initials: AT
authors.lastname: Dierick-van Daele
authors.forename: Cor
authors.initials: C
authors.lastname: Spreeuwenberg
authors.forename: Emmy W C C
authors.initials: EW
authors.lastname: Derckx
authors.forename: Yvonne
authors.initials: Y
authors.lastname: van Leeuwen
authors.forename: Thea
authors.initials: T
authors.lastname: Toemen
authors.forename: Marja
authors.initials: M
authors.lastname: Legius
authors.forename: Joyce J M
authors.initials: JJ
authors.lastname: Janssen
authors.forename: Job F M
authors.initials: JF
authors.lastname: Metsemakers
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D009426:Netherlands; D009722:Nurse Practitioners; D005791:Patient Care / Q000379:methods; D011787:Quality of Health Care / Q000458:organization & administration