Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review

Abstract

Aim: Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.

Design: Scoping review.

Methods: A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist.

Data sources: PubMed, CINHAL and Embase for articles between 2016 and 2023.

Results: Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management.

Conclusion: Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.

Implications for the profession and/or patient care: Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care.

Impact: Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.

Patient or public contribution: No patient or public contribution is required for this study.

Keywords: access to care; advanced practice nursing; health services; healthcare costs.