Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential
Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential
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DOI：
10.1136/bmjopen-2016-011901
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Busse, Reinhard
中科院分区：
文献类型：
--
作者：
Maier, Claudia B.;Barnes, Hilary;Busse, Reinhard
目标：许多国家在初级保健方面面临提供者短缺和不平衡的问题，或者由于慢性病和多种疾病的增加而预计将来会出现短缺。为了评估护士从业人员（NPs）在扩大可及性方面的潜力，我们分析了6个经济合作与发展组织（OECD）国家NPs的规模、年增长率（2005-2015年）和先进实践的程度。设计：对各国护理登记、监管机构、统计机构数据以及经合组织卫生人力和人口数据进行跨国数据分析，并进行文献范围审查。背景/参与者：6个经合组织国家（澳大利亚、加拿大、爱尔兰、荷兰、新西兰和美国）的NP和医生工作人员。主要和次要结局指标：主要结局指标是每10万人口中护理人员和医生劳动力的绝对和相对数量，复合年增长率，2005年至2015年的年度和中位数百分比变化，以及由医生替代效应衡量的高级临床实践程度的文献综合。结果：美国的NPs绝对数量和发病率最高（40.5 / 100000），其次是荷兰（12.6 / 100000）、加拿大（9.8 / 100000）、澳大利亚（4.4 / 100000）、爱尔兰和新西兰（3.1 / 100000）。所有国家的年增长率都很高，从美国的6.1%到荷兰的27.8%不等。增长率是医生的3到9倍。最后，来自文献范围审查的实证研究表明，np能够提供67-93%的初级保健服务，然而，基于有限的证据。结论：NPs是一支快速增长的劳动力队伍，在初级保健方面具有高水平的高级实践潜力。基于准确数据的劳动力监测对于告知教育能力和劳动力规划至关重要。
Objectives: Many countries are facing provider shortages and imbalances in primary care or are projecting shortfalls for the future, triggered by the rise in chronic diseases and multimorbidity. In order to assess the potential of nurse practitioners (NPs) in expanding access, we analysed the size, annual growth (2005-2015) and the extent of advanced practice of NPs in 6 Organisation for Economic Cooperation and Development (OECD) countries.Design: Cross-country data analysis of national nursing registries, regulatory bodies, statistical offices data as well as OECD health workforce and population data, plus literature scoping review.Setting/participants: NP and physician workforces in 6 OECD countries (Australia, Canada, Ireland, the Netherlands, New Zealand and USA).Primary and secondary outcome measures: The main outcomes were the absolute and relative number of NPs per 100 000 population compared with the nursing and physician workforces, the compound annual growth rates, annual and median percentage changes from 2005 to 2015 and a synthesis of the literature on the extent of advanced clinical practice measured by physician substitution effect.Results: The USA showed the highest absolute number of NPs and rate per population (40.5 per 100 000 population), followed by the Netherlands (12.6), Canada (9.8), Australia (4.4), and Ireland and New Zealand (3.1, respectively). Annual growth rates were high in all countries, ranging from annual compound rates of 6.1% in the USA to 27.8% in the Netherlands. Growth rates were between three and nine times higher compared with physicians. Finally, the empirical studies emanating from the literature scoping review suggested that NPs are able to provide 67-93% of all primary care services, yet, based on limited evidence.Conclusions: NPs are a rapidly growing workforce with high levels of advanced practice potential in primary care. Workforce monitoring based on accurate data is critical to inform educational capacity and workforce planning.