Mary Hawking wrote:
>
> In message <[log in to unmask]>, John Marwick
> <[log in to unmask]> writes
> >Robert Bracchi wrote:
> >>
> >> Question:
> >> How long will it be before there is a study showing that Nurse Practitioners
> >> are cheaper, do less investigations,do less referrals and are prefered by
> >> patients than the average GP?
> >>
> >> Answer?
> >>
> >> Robert Bracchi
> >
> >An interesting question.
> >
> >There was a famous randomised trial in Canada in the early 1970s
> >(Spitzer WO, et al. The Burlington randomized trial of the nurse
> >practitioner. (N Engl J Med, 1974 Jan 31)
> >
> >and I have just found a meta-analysis on Medline. Here is the URL:
> >
> >http://www.healthgate.com/cgi-bin/HealthGate/library/nph-db-
>
>search.cgi?s1=((nurse-practitioners).A06D,A06C.+OR+(nurse+AND+practitioner))+AND
>
>+AB=TRUE+AND+LA=ENG+AND+(@YM+%3E=199408)&d=XX02§1=FREE+MEDLINE§2=XOFF&se
>
>ct3=PLURON&l=50&p=2&u=/HealthGate/MEDLINE/search.shtml&r=60&f=G&key=96101816
> >
> >Both these articles show that the evidence does indeed support the
> >effectiveness, safety and patient-acceptability of independent nurse
> >practitioners in primary care. I understand the evidence about
> >cost-effectiveness is arguable - and would certainly depend on the cost
> >structures where the trials are carried out.
> >
> >Don't look at these if you don't want to know!
> >
> the length of that URL makes sure that us non-techie types would find it
> hard to look! Any short cuts on offer?
> Mary
> Sorry about this reference. Here is a copy of what I found on medline:
Title
A meta-analysis of nurse practitioners and nurse midwives in
primary care.
Author
Brown SA; Grimes DE
Address
School of Nursing, University of Texas at Austin, USA.
Source
Nurs Res, 44: 6, 1995 Nov-Dec, 332-9
Abstract
This meta-analysis was an evaluation of patient outcomes of nurse
practitioners (NPs) and nurse midwives (NMs), compared with those of
physicians, in primary care. The sample included 38 NP and 15 NM
studies. Thirty-three outcomes were analyzed. In studies that employed
randomization to provider, greater patient compliance with treatment
recommendations was shown with NPs than with physicians. In studies that
controlled for patient risk in ways other than randomization, patient
satisfaction and resolution of pathological conditions were greater for
NP patients. NPs were equivalent to MDs on most other variables in
controlled studies. In studies that controlled for patient risk, NMs
used less technology and analgesia than did physicians in intrapartum
care of obstetric patients. NMs achieved neonatal outcomes equivalent to
those of physicians. Limitations in data from primary studies precluded
answering questions of why and under what conditions these outcomes
apply and whether these services are cost-effective.
The Canadian study (Burlington) from NEJM is a 'classic' which has
recently been reprinted. One of its authors is Sackett D - I assume
Dave Sackett of EBM fame.
--
Dr John Marwick, NZ Ministry of Health, PO Box 5013, Wellington, NZ
Home: 12 Konini St, Eastbourne, Lower Hutt, NZ
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