title: Quality of primary care by advanced practice nurses: a systematic review.
abstract: OBJECTIVE
  To conduct a systematic review of randomized controlled trials (RCTs) of the safety and effectiveness of primary care provided by advanced practice nurses (APNs) and evaluate the potential of their deployment to help alleviate primary care shortages.
  
  
  METHODS
  PubMed, Medline and the Cumulative Index to Nursing and Allied Health Literature.
  
  
  METHODS
  RCTs and their follow-up reports that compared outcomes of care provided to adults by APNs and physicians in equivalent primary care provider roles were selected for inclusion.
  
  
  METHODS
  Ten articles (seven RCTs, plus two economic evaluations and one 2-year follow-up study of included RCTs) met inclusion criteria. Data were extracted regarding study design, setting and outcomes across four common categories.
  
  
  RESULTS
  The seven RCTs include data for 10 911 patients who presented for ongoing primary care (four RCTs) or same-day consultations for acute conditions (three RCTs) in the primary care setting. Study follow-up ranged from 1 day to 2 years. APN groups demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction and cost. APNs generally had longer consultations compared with physicians; however, two studies reported that APN patients required fewer consultations over time.
  
  
  CONCLUSIONS
  There were few differences in primary care provided by APNs and physicians; for some measures APN care was superior. While studies are needed to assess longer term outcomes, these data suggest that the APN workforce is well-positioned to provide safe and effective primary care.
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Swan
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Sacha
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Chang
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA ams130@columbia.edu.
authors.forename: Arlene
authors.initials: A
authors.lastname: Smaldone
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009722:Nurse Practitioners / Q000592:standards*; D017060:Patient Satisfaction; D058007:Physicians, Primary Care / Q000592:standards*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D016032:Randomized Controlled Trials as Topic
keywords: advanced practice nursing; nurse practitioners; primary care; quality of healthcare