A systematic review of quality of primay care: A comparison of physicians and advance practice nurses

Sarah Simmons, The University of Texas School of Public Health


Access to primary care in the United States is limited, with large portions of the country qualifying as medically underserved areas. A decrease in the number of physicians choosing to practice in primary care, in conjunction with the implementation of the Affordable Care Act, means that this care access gap will continue to widen. This dissertation was conducted as an effort to expand the available research on the use of advance practice nurses as primary care providers. In many parts of the country, advance practice nurses function as independent primary care providers. However, there are states that place restrictions on the scope of practice for advance practice nurses due to concerns regarding the quality of care that they provide. ^ This research aims to compare the quality of primary care provided by advance practice nurses and primary care physicians. Quality was defined using three different components; effectiveness, safety, and patient-centeredness. The focus of this research was the chronic health conditions of heart disease and diabetes. A systematic review was conducted that searched for studies on quality indicators for patients with heart disease and diabetes, and that directly compared advance practice nurses with physicians in a primary care setting. Data was abstracted from identified studies and grouped into one of the three quality components. Data within each quality component was further grouped by theme and data type, and meta-analysis was conducted using a random effects model. ^ Meta-analysis was conducted for data sets in which more than one study was identified that reported data that was of interest in this study. For effectiveness, the completed analyses indicated that advance practice nurses were better than or equal to physicians in regards to the magnitude of improvement or odds of reaching an outcome goal. For safety, advance practice nurses were found to have significantly less knowledge than physicians. For patient-centeredness, advance practice nurses were found to be better than or equal to physicians with regard to the self-reported satisfaction of patients receiving care. This study expands on recent reviews of the use of APNs as primary care providers by using meta-analysis methods as opposed to qualitative methods.^

Subject Area

Medicine|Health care management

Recommended Citation

Simmons, Sarah, "A systematic review of quality of primay care: A comparison of physicians and advance practice nurses" (2015). Texas Medical Center Dissertations (via ProQuest). AAI3720109.