Patient characteristics and health consumption of patients at three months follow-up visiting either the Advanced Nurse Practitioner or the General Practitioner in primary care.

Abstract

Background: more patients with increased complexity in primary care are caused by substitution from secondary to primary care, more elderly and more chronically ill patients. One of the interventions to keep the primary care effective might be the deployment of Advanced Nurse Practitioner’s (ANP’s). However, little is known about the impact of the ANP in primary care on healthcare consumption in the Netherlands. Aim: To explore and compare patient characteristics and healthcare consumption of primary care patients visiting either the ANP or the General Practitioner (GP) at three months follow-up. Method: A quantitative, observational prospective cohort study has been conducted at three Dutch primary care practices from July 2017 till January 2018. Patients who had initially been treated by an ANP or GP were followed-up for three months for their healthcare consumption with electronic routine care data. A joint ANP-GP relative frequency diagnostic code distribution has been performed to include patients within the ANP scope-of-practice. Differences in number of re-consultations and referrals to other healthcare providers between the ANP and GP group have been tested by Mann-Whitney U tests at the 0.05 alpha level. Results: 1303 patients visited an ANP and 6580 patients a GP, which, after performing the selection method, resulted in 865 ANP and 3684 GP patients. Results showed that the ANP group was younger and had less multimorbidity compared with the GP group. No difference in re-consultations was found, but ANP’s performed more home-visits (0.05 vs 0.014) and wrote fewer referrals (0.03 vs 0.06). Conclusion: Patients who are visiting the ANP have different characteristics, are receiving the same number of re-consultations at three months follow-up, but receive fewer referrals compared to GP patients. Recommendations: Further research should focus on the association between different patient characteristics and healthcare consumption and to the ideal ANP:GP ratio in primary care