Evidence map›Paper›PMID 10764367›Full record

Trial reportBMJ (Clinical research ed.)2000

Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.

P Venning, A Durie, M Roland, C Roberts, B Leese

Registry-linked trialAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00461201 (Effectiveness of an Intervention in Primary Care), which is not on this map. Cited by 94 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
94citing papers in PubMed, 13 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00461201 naunknown statusnot on this mapstarted 2009, after this paper: background citation

Effectiveness of an Intervention in Primary Care: Randomized Controlled Trial Comparing Care for Patients Requesting Same Day Consultations by Nurse Practitioner vs General Practitioners

TypeinterventionalSponsorCatalan Institute of HealthRan2009Enrolled1,640ConditionsAcute Disease, Nursing Care, Ambulatory Care, Family PracticeArmsNurse practitioner care of patients
3 · Its place in the literature

Who cites it

94 citing papers in PubMed, 13 syntheses or guidelines pooled it.

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  4. Nurses as substitutes for doctors in primary care.The Cochrane database of systematic reviews · 2018
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  10. Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials.The British journal of general practice : the journal of the Royal College of General Practitioners · 2006
    Pooled it
  11. Systematic review of recent innovations in service provision to improve access to primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2004
    Pooled it
  12. Walk-in centres in primary care: a review of the international literature.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003
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  19. Comparison of GP and nurse practitioner consultations: an observational study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2005
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34 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

P VenningUniversity of Manchester School of Primary Care, Rusholme Health Centre, Manchester M14 5NP. pamelavenning@gofree.co.uk
A Durie
M Roland
C Roberts
B Leese

Funding

Wellcome Trust
6 · The paper itself

Abstract

objectiveTo compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care.

designMulticentre randomised controlled trial of patients requesting an appointment the same day.

setting20 general practices in England and Wales.

participants1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations).

main outcome measuresConsultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs.

resultsNurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4. 20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37. 2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner 18.ll pound sterling v general practitioner 20.70 pound sterling adjusted difference 2.33 pound sterling - 1.62 pound sterling to 6.28 pound sterling).

conclusionsThe clinical care an health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.

Indexed as

AdolescentAdultAgedChildChild, PreschoolCost-Benefit AnalysisEnglandFamily PracticeHumansInfantInfant, NewbornMiddle AgedNurse PractitionersPatient Acceptance of Health CarePatient SatisfactionPractice Patterns, Physicians'

Identifiers

PMID10764367
PMCPMC27348

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.