Primary Care and Nursing

¶ … Nursing Practitioners In the United States and the United Kingdom, NP (Nursing practitioners) are being used as a point of contact to deliver primary care for patients. Trained nursing practitioners who can deliver in-person primary healthcare services for patients are gradually increasing. While patients provide positive feedback about the nursing roles, there is still a debate whether nursing practitioners can deliver a cost effectiveness for a patients' treatment compared with other healthcare professionals, and deliver quality healthcare. (Venning, et al. 2000).

The objective of this study is to review the literature that provides the cost effectiveness of nursing practitioners. The study reviews six different literature to enhance a greater understanding of the cost effectiveness of nursing practitioners in the healthcare environment. Synthesis and Analysis of the Articles Venning, et al. (2000) provide a random trial on the cost effectiveness of the nursing practitioners in the United Kingdom sampling NPs in 20 geographical regions in the United Kingdom.

The evaluation was carried out on the nursing practitioners who have completed a two-year program in nursing education. The evaluation was also carried for nurses who have BSc or Master degree in Nursing and were qualified as nurses for at least 3 years and seeing patients for at least two years. Venning, et al. (2000) collect data from 1,316 patients who seek for the service of nurses to evaluate the effectiveness of nursing practitioners.

The outcome of the evaluation reveals that satisfactions among patients were significantly higher showing that the benefits that patients secure from nurses are higher than the costs incurred for the services. Generally, patient satisfactions are critical in assessing the cost effectiveness of the services of nursing practitioners. It is revealed that patients turn around with nursing practitioners are higher than general practitioners because the health consultations costs for nurses are 12.5% lower than for general practitioners.

Fletcher, Copeland, Lowery, (2011) support the argument of the previous authors by explaining that nursing practitioners can provide primary care that is underutilized within the healthcare environment. By acquiring skills in patient care management and physical assessment, NP can become primary care providers delivering services such as diagnosing, ambulatory care settings and providing treatments for a variety of health problems. The authors evaluate the cost effectiveness of nursing practitioners in the Department of Veterans in the United States.

The study verifies the quality care for outpatient services, medication prescriptions, and laboratory results services. The outcome of the research reveals that the number of Veterans who seek for the primary healthcare services from nursing practitioners since 1996 has increased by more than 200%. For example, 75% of patients agree using the services of NP in 1996, however, the number of patients using the NP services increased to 90% in 1999.

Through clinical practice and on-going education, the NPs are able to deliver "a wide range of healthcare services including diagnosis and treatment of acute conditions." (Fletcher, Copeland, Lowery, 2011 p 794). Despite the analysis of the cost-effectiveness of NPs carried out by the previous studies, the articles did not compare the direct costs versus direct healthcare benefits derived from patients. Litaker, Mion, Planavsky, (2003) is able to address this shortcoming by demonstrating that there are modest incremental costs for a complementary team approach for the management of chronic disease.

The authors reveal that intervention of NPs and medical practitioners increases HDL-c prevalence by 7%, however, HbA1c for diabetes patients reduces from 7.9% to 7.0%. The microvascular complications were reduced by 25% and a reduction of 16% for non-fatal, fatal sudden death and myocardial infarction were recorded. Despite cost effectiveness carried out for NPs, the authors did not include personnel costs in their evaluation. Allen, Himmelfarb, Szanton, et al. (2014) provides a comprehensive research on the cost-effectiveness of an intervention of nursing practitioners on patients suffering from CVD (cardiovascular disease).

In the United States, the CVD is the leading cause of death among adults especially among lower income category. While the evidence-based practice to manage CVD is available, however, patient adherence to the therapies is slow. The authors argue that nursing practitioners can assist in providing the quality care at lower costs similar to the healthcare services delivered by other health care professionals. With the intervention of the nursing practitioners, the authors calculate the total costs per patients to manage the CVD.

The outcome of the study reveals that the total costs per patient are $627. Moreover, the cost effectiveness shows that there is $157 reduction in cost for 1% drop in the systolic blood pressure. Moreover, $190 decline in cost for 1% drop in the diastolic blood pressure. Additionally, there is $149 decline in the cost of 1% per drop of HbA1c. A $40 decline in costs in 1% drop in LDL cholesterol is also recorded. The outcome of their research shows that management of CVD by NP is cost-effective for patients suffering from the high risk of CVD.

Kapu, Kleinpell,. & Pilon, (2014) contribute to the argument by investigating the financial impact of NPs on inpatients at Vanderbilt University Hospital. The investigation was carried out based on the national initiatives targeting the cost effectiveness of NPs in the optimal healthcare environment because the health administrators believe that NPs can deliver cost savings as well as reducing costs of administration. The authors analyze the ROI (return on investment) after adding five teams of NPs. The software is used to evaluate the length of stay, and NPs quality metrics.

The data collected were compared with the previous year's data. The finding of the research reveals that NPs demonstrated a huge decline in costs revealing that NPs used fewer resources in delivering a standardized quality of care. Schuttelaar, Vermeulen, Coenraads, (2011) add to the arguments of the previous authors by investigating the cost effectiveness of using NPs to treat children suffering from eczema compared with the costs charged by dermatologists. The costs of treating children with eczema using NPs and dermatologists were collected for a given year.

The findings show that "substituting nursing practitioners for dermatologists is both cost-effective and cost-saving. Treatment provided by the NPs is similarly effective to the treatment provided by a dermatologist with a higher parent satisfaction." (Schuttelaar, Vermeulen, Coenraads, 2011 p 600). IV. Discussion of literature Findings A shortage of the healthcare professionals has been one of the major factors that lead to an increase in the costs of treating patients in the United States.

For several decades, nurses serve as an assistant for the general practitioners with no right to implement the professional practice. In the last few decades, nurses have been allowed to provide the professional practice delivering health care for patients. However, the point of the argument is whether NPs can deliver effective cost savings and quality of care compared with.