Trial reportBMC family practice2016
The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study.
Trial report in BMC family practice, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01388374 (A Study on the), which is not on this map. Cited by 15 papers, 3 of them syntheses that pooled 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.
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.
A Study on the (Cost-)Effectiveness of Nurse Practitioners Working at the Primary Out of Hours Emergency Service and the Feasibility of Implementing These Nurses
Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting.The European journal of general practice · 2024Pooled it
- Nurse practitioners and physician assistants working in ambulance care: A systematic review.F1000Research · 2020Pooled it
- Primary care professionals providing non-urgent care in hospital emergency departments.The Cochrane database of systematic reviews · 2018Pooled it
- Task shifting from general practitioners to nurses and the association with patient flow and resource use in out-of-hours primary care clinics: a descriptive register-based study.Scandinavian journal of primary health care · 2026Article
- Task shifting from general practitioners to nurses in out-of-hours primary care: an explorative case study of team-based practices.Scandinavian journal of primary health care · 2025Article
- Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review.Journal of clinical nursing · 2025Article
- Comparing independent prescribing to patient group direction use in a general practitioner out-of-hours service: a retrospective cross-sectional service evaluation.British paramedic journal · 2024Article
- The effect of general practice team composition and climate on staff and patient experiences: a systematic review.BJGP open · 2024Article
- The Effect of Supervision Waivers on Practice: A Survey of Massachusetts Nurse Practitioners During the COVID-19 Pandemic.Medical care · 2021Article
- A Value-Based Comparison of the Management of Ambulatory Respiratory Diseases in Walk-in Clinics, Primary Care Practices, and Emergency Departments: Protocol for a Multicenter Prospective Cohort Study.JMIR research protocols · 2021Article
- Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study.BMC family practice · 2020Article
- [Skill mix of nurses and primary health care professionals: a systematic review].Revista panamericana de salud publica = Pan American journal of public health · 2020Review
- New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning.BMC health services research · 2019Article
- Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review.Nursing economic$Article
- Prescribing and Administration of Opioid Analgesics in Residents of Aged Care Facilities.Journal of research in pharmacy practiceArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a lack of knowledge about the impact during out-of-hours. The current study aims to provide an insight into the impact of substitution on resource use, production and direct health-care costs during out-of-hours.
methodsAt a general practitioner cooperative (GPC) in the south-east of the Netherlands, experimental teams with four GPs and one NP were compared with control teams with five GPs. In a secondary analysis, GP care versus NP care was also examined. During a 15-month period all patients visiting the GPC on weekend days were included. The primary outcome was resource use including X-rays, drug prescriptions and referrals to the Emergency Department (ED). We used logistic regression to adjust for potential confounders. Secondary outcomes were production per hour and direct health-care costs using a cost-minimization analysis.
resultsWe analysed 6,040 patients in the experimental team (NPs: 987, GPs: 5,053) and 6,052 patients in the control team. There were no significant differences in outcomes between the teams. In the secondary analysis, in the experimental team NP care was associated with fewer drug prescriptions (NPs 37.1 %, GPs 43 %, p < .001) and fewer referrals to the ED (NPs 5.1 %, GPs 11.3 %, p = .001) than GP care. The mean production per hour was 3.0 consultations for GPs and 2.4 consultations for NPs (p < .001). The cost of a consultation with an NP was €3.34 less than a consultation with a GP (p = .02).
conclusionsThese results indicated no overall differences between the teams. Nonetheless, a comparison of type of provider showed that NP care resulted in lower resource use and cost savings than GP care. To find the optimal balance between GPs and NPs in out-of-hours primary care, more research is needed on the impact of increasing the ratio of NPs in a team with GPs on resource use and health-care costs.
trial registrationClinicalTrials.gov ID NCT01388374 .
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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.