Evaluation of initial implementation of an organized adult health program employing family nurse practitioners

Abstract

An organized program for periodic health evaluation of adults was instituted at one Group Health Cooperative Clinic (A) using a fixed exam schedule and two family nurse practitioners (FNPs), working in a team with six family practitioners, to perform as many of the examinations as possible. We evaluated the effects of the FNP program at Clinic A in terms of six specific objectives, comparing it with the preexisting conventional pattern in another clinic (B). The evaluation showed 1) diminished waiting times at Clinic A; 2) no diminution in quality of examinations performed by FNPs; 3) lesser unit costs in Clinic A; 4) no indication of higher overall postexam outpatient utilization or costs for those examined by FNPs; 5) greater patient satisfaction at Clinic A than Clinic B, and for those examined by FNPs, compared with those examined by physicians (MDs); 6) only 17 per cent of FNP time was spent on health evaluations and met one half the overall demand at Clinic A; 7) FNPs made day-to-day practice qualitatively more complex for some MDs; and 8) different staffing ratios are probably necessary when FNPs are teamed with family physicians rather than internists.