Table 3 Summary of included studies with regard to complexity
Source | Use | Context |
|---|---|---|
Qualitative Study Design | ||
O’Brien et al. [23], US | complex medical issues | GPs take leadership with complex medical issues while NPs have a different focus. |
Parker et al. [24], AU | complex medical concerns | GPs care for more complex medical conserns while NPs treat minor ailments. |
O’Malley et al. [25], US | complex (care) needscomplex patients | Offloading tasks enables physicians to care for patients with complex needs. NCM also work with complex patients. |
Van der Biezen et al. [26], NL | complex patientscomplex caseloadscomplex complaints | NPs enable GPs to focus on and have more time for complex patients leading to a more complex caseload while NPs treat less complex patients. |
Lovink et al. [27], NL | complex care complex patients | GPs and NPs report that NPs are competent to perform geriatric assessments in older adults with complex care needs. However, the introduction of NPs in general practice means that GPs focus on more complex patients. |
Boman et al. [28], NO/FI | complex care needs | NPs act as case managers especially for patients with complex care needs and comorbidity. |
Côté et al. [29], CA | complex patients | GPs report their case loads including more medically complex patients upon collaborating with NPs who care for less medically vulnerable patients. |
Pelletier et al. [30], CA | complex health situations complex cases | NPs enable GPs to manage more chronically ill patients while treating minor medical problems. |
Quantitative Study Designs | ||
Ohman-Strickland et al. [31], US | complex patients | Practices with NPs could improve efficiency and individualisation of care because physicians could care for complex patients while NPs could introduce preventative approaches. |
Everett et al. [32], US | complexity of populations | Populations served by NPs and doctors do not differ in complexity. |
Subramanian et al. [33], US | decision-making complexity complex patients | NPs working independently with delayed physician supervision care for patients with high decision-making complexity. |
Yarnall et al. [34], US | complex medical care issues | NPs can expand amount of time available for patients and free up physician’s time for complex medical care. |
Chung et al. [35], US | complex conditions complex patients | NPs enabled practices to contentrate on and provide appropriate care to complex patients thus reducing the number of referrals to specialists. |
Mian et al. [36], CA | complex care | FPs refer patients to NPs who serve as substitutes for less complex care. |
Morgan et al. [37], US | complexity scorespatient complexity medically complex complex patients | Despite NPs and physicians having a similar complexity score, indicating NPs do treat complex patients, according to patient encounters physicians treat slightly more complex patients. |
Donelan et al. [38], US | complex cases complex chronic conditions | Double the amount of physicians compared to NPs report that physicians treat more complex cases. A third of physicians report that NPs provide services for complex conditions. |
Everett et al. [39], US | complex patients | NPs in a supplementary role who do not treat complex patients have similar or better outcomes compared to physician-only care. Whereas NPs in a supplementary role who do treat complex patients have worse outcomes than physician-only care. |
Everett et al. [40], US | socially complex patients clinical complexity complex patients | Compared to physicians, NPs as usual providers treat more socially complex patients and similar clinical complexity. However, NPs as usual providers refer patients to physicians significantly more often than the reverse. |
Dahrouge et al. [41], CA | complex medical conditions medical complexity medically complex patients socially complex patients | FPs care for patients with more complex medical conditions. NPs care for patients with less medical complexity to minimise consultations with family physicians. Compared to FPs, NPs treat more socially complex patients. |
Ku et al. [42], US | complexity of care complex visits complex conditions | Pysicians are more involved in complex visits and overall involved in the care of patients with complex conditions compared to NPs. |
Kuo et al. [43], US | medically complex individuals | NPs recognise limitations when treating medically complex individuals. Overall NPs may treat less medically complex patients than PCPs. |
Park [44], US | complex cases | NPs in practices can increase accommodation and care coordination of patients because the physician’s time is freed up for complex cases. |
Reckrey et al. [45], US | complex medical and psychosocial needs complex care situations complex patients | Team-based models of care are needed to treat complex medical and psychosocial needs. NPs take an enhanced role in the management of the most complex patients in team approach physician panels. |
complex patient panels | PCPs prescribe more medication on account of their patient panel being more compelx than that of NPs. | |
Raji et al. [48], US | complex health conditions | A team approach including NPs and MDs may be best for patients with complex health conditions. |
Van der Biezen et al. [49], NL | minor ailments task complexity | NPs treat a patient panel with minor ailments. |
D’Afflitti et al. [50], US | complex patients | NPs cared reach out to medically and socially complex patients to engage them in care. |
Yang et al. [51], US | medical complexity | NPs caring for diabetic patients in the VHA treat similar medical complexity as GPs. |
Morgan et al. [52], US | complex patients | NPs provide care for medically complex patients without increasing costs. |
Other Study Designs | ||
Fletcher et al. (mixed methods) [53], US | complex patients complex cases complexity of patients | NPs can increase access for more patients and free up physician’s time for complex patients. In physician’s opinion NPs can only treat complex cases under constant, direct physician supervision. In physician’s opinion NPs should treat low complexity patients. |
Dierick-van Daele et al. (mixed methods) [54], NL | minor health problems complex care | NPs should care for common complaints and minor health problems freeing up GP’s time for patients with chronic diseases and multimorbidity. According to a direct quote from one GP complex care is best shared by a GP and a NP. |
Sustaita et al. (review) [55], US | complex patients | NPs can free up physicians’ time by taking over routine tasks and allowing physicians to treat complex patients. |
Freund et al. (comparison) [56], NL | complex presentations (minor illnesses) | NPs in the Netherlands are responsible for clinical diagnosis and treatment of less complex presentations and chronic care management. |
Helms et al. (case study) [57], AU | complex conditionscomplex chronic diseases | The NP has his own caseload and receives referrals from other team members according to expertise and interest. The NP increased GP productivity by caring for patients with complex diseases. |
complex health care needs | When GPs and NPs collaborate, GPs will lead the team caring for people with complex health care needs. | |
Hunter et al. (mixed methods) [59], CA | complex patients | NPs improve access for complex patients in an area short of primary care providers. |
Collins (mixed methods) [60], UK | complex conditions | NPs treat a range from minor illness to complex conditions such as cancer. |