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09-08-2011 | Legal medicine | Article

Nurse care equivalent to physician, could reduce cost in hospital setting

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MedWire News: Advanced practice registered nurse providers give safe, effective, quality care in a variety of patient settings and could reduce lengths of stay and the cost of care for some hospitalized patients, say US researchers.

The systematic review, covering 18 years of data, shows that patient outcomes of care when provided by nurse practitioners are similar to "and in some ways better" than care provided by physicians alone.

For example, the team found high-level evidence that women attended by certified nurse-midwife (CNM) groups have lower rates of episiotomy than those whose care is given by a doctor of medicine.

"The ideal health system comprises multiple providers who communicate with and are accountable to each other to deliver coordinated care," write Julie Stanik-Hutt (University of Maryland School of Nursing, Baltimore) and colleagues in the journal Nursing Economics.

The team believes US healthcare professionals need to move forward with evidence-based, collaborative models of healthcare delivery in order to "promote unified health goals."

The review included 69 randomized controlled trials and observational studies, conducted between 1990 and 2008, that assessed patient outcomes of care from at least two groups of healthcare providers.

A total of 37 studies directly compared care outcomes from nurse practitioners and physicians alone, and found equivalent levels of self-reported patient satisfaction, perceived health, and functional status, equivalent levels of glucose and blood pressure control, and equivalent rates of emergency department visits and duration of mechanical ventilation.

The results did show high-level evidence to support better control of patient lipid levels after care with a nurse practitioner compared with a physician, note Stanik-Hutt and co-researchers.

Among the 21 studies involving outcomes of care from CNMs compared with physicians alone, evidence existed for lower rates of cesarean section, epidurals, episiotomy, vaginal operative delivery, labor analgesia, and lower levels of third- and fourth-degree perineal lacerations during CNM-led versus physician-only care.

Apgar scores among infants and rates of labor induction were equivalent after care from both types of healthcare provider.

In studies involving clinical nurse specialists (CNS), Stanik-Hutt and team found high levels of evidence to support equivalent or lower lengths of stay after care from these providers compared with physicians. CNSs were also associated with lower costs of care and fewer patient complications.

"The study isn't about who is a better health provider. Rather, the study suggests the value of enabling both doctors and advanced practice nurses each to do what they do best in a collaborative, but autonomous environment," commented Stanik-Hutt.

"When each profession works to its strengths, without the fetters of current regulatory restrictions, the unique contributions of both shine through," she concluded.

By Sarah Guy

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