Nurse practitioners are nurses who have undergone further training, often at graduate level, to work autonomously; making independent diagnoses and treatment decisions. It is important to consider whether the evidence supports the notion that nurse practitioners can substitute for doctors by providing safe, effective, and economical front line manage-ment of patients. Key messages Low to moderate quality evidence indicates that patient health outcomes were similar for nurse practitioners and doctors, but that patient satisfaction and quality of care were better for nurse practitioners. Moderate quality evidence suggests that nurse practitioners had longer consultations and undertook more investigations than doctors. No significant differences between nurse practitioners and doctors were found regarding numbers of prescriptions, return consultations and referrals. The studies included in the review were conducted in high-income countries and do not provide high quality evidence of the economic impacts of substituting nurse practi-tioners for doctors. Who is this summary for? People making decisions concerning substitution of doctors by nurses in primary care. This summary includes: − Key findings from research based on a systematic review − Considerations about the relevance of this research for low and middle-income countries Not included: − Recommendations − Additional evidence not included in the systematic review − Detailed descriptions of interventions or their implementation This summary is based on the following systematic review: Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ 2002;324:819-23.
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