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Practice nurse-led care ‘equal to or better’ than GP-led care, review finds

Care provided by practice nurses is as good as care provided by GPs and may even be better, according to a new review.

Nurse-led primary care may lead to improved mortality rates, blood pressure outcomes and patient satisfaction compared to GP-led care, according to the research.

A meta-analysis of the study results showed evidence for improved mortality in nurse-led care, with six in 1,000 patients dying under doctor-led care and between four and six per 1,000 dying under nurse-led care.

It also showed that blood pressure outcomes were slightly improved under nurse-led care, with practice nurses improving systolic blood pressure by just under 4mmHg, compared to GPs.

Patients were more likely to be satisfied with practice nurse care than GP care, although the difference between the two was marginal.

Practice nurse-led care was found to be just as good as GP-led care for other clinical outcomes, including controlling a patient’s HbA1c and cholesterol levels.

There was also no difference between practice nurses and GPs for patient-reported pain in those with rheumatoid arthritis.

The review was led by researchers in the Netherlands and looked at 18 studies investigating outcomes in nurse-led primary care based mostly in Europe and North America.

The authors pointed out that much of the evidence was of low-to-moderate certainty due to wide confidence intervals in the results and variation in the design of the studies.

They said in the paper: ‘This review shows that trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide care that is equal to or of better quality than that provided by primary care doctors, and probably achieve equal or better health outcomes for patients.

‘Although the included studies show effects of an independent practice role for nurses, it is likely that the quality of patient care overall is determined by overall functioning of the primary care team, including nurses, doctors, and other healthcare providers.

‘Policy makers should be aware that implementing nurse substitution in primary care teams may have an influence on the functioning and quality of care delivered by the entire care team.’

Cochrane Database Syst Rev 2018; online 16 Jul