Abstract
Rising demand for and costs of health care have led to an increasing role of practice nurses in primary care in many countries, including the United Kingdom. Previous research has explored how practice nurse care differs from that provided by general practitioners (GPs) in terms of costs and health outcomes, and has highlighted the importance of matching skills and experience with roles and responsibilities. However, there has been little research to compare the characteristics of patients seen by GPs and practice nurses in primary care. We aim to investigate the factors associated with the use of practice nurse visits, and to compare these with the factors associated with GP use. We jointly model the use of practice nurse and GP visits using a bivariate probit regression model with a large set of covariates taken from two rounds of the Health Survey for England (2001, 2002). We find that practice nurse use is associated with age and gender, health, socioeconomic and supply variables. There are differences in the factors associated with practice nurse and GP use. Chronically ill patients are more likely to see a practice nurse, while acute ill health has a stronger association with the probability of seeing the GP. Practice nurse use is also correlated with a narrower range of health conditions compared with GP use. We also found differences between practice nurse and GP visits with respect to the association with economic activity, ethnic group, number of children, degree of urbanisation, and distance to practice.
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References
Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R., Sibbald, B.: Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev 18(2), CD001271 (2005)
Sibbald, B., Laurant, M., Scott, A.: Changing task profiles. In: Satlman, R.B., Rico, A., Boerma, W. (eds.) Primary Care in the Driver’s Seat? Organisational Reform in European Primary Care, pp. 149–164. Open University Press, Berkshire (2006)
Royal College of General Practitioners: Practice Nurses: RCGP Information Sheet No. 19. Royal College of General Practitioners, London (2004)
Williams, A., Sibbald, B.: Changing roles and identities in primary health care: exploring a culture of uncertainty. J. Adv. Nurs. 29, 737–745 (1999)
Chapple, A., Rogers, A., MacDonald, W., Sergison, M.: Patients’ perceptions of changing professional boundaries and the future of nurse led services. Primary Health Care Research and Development. 1, 51–59 (2000)
Information Centre for Health and Social Care: General and Personal Medical Services Staff Bulletin, 1997–2007. Information Centre for Health and Social Care, Leeds (2008)
Department of Health: Liberating the Talents: Helping Primary care Trusts and Nurses to Deliver the NHS Plan. Department of Health, London (2002)
Horrocks, S., Anderson, E., Salisbury, C.: Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 324, 819–823 (2002)
Hollinghurst, S., Horrocks, S., Anderson, E., Salisbury, C.: Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials. Br. J. Gen. Pract. 56, 530–535 (2006)
National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2001–2002 Colchester, Essex: UK Data Archive [distributor]
Information Centre for Health and Social Care: General Medical Statistics Database, 2001. Information Centre for Health and Social Care, Leeds (2008)
Sutton, M., Gravelle, H., Morris, S., Leyland, A., Windmeijer, F., Dibben, C., Muirhead, M.: Allocation of Resources to English Areas; Individual and Small Area Determinants of Morbidity and Use of Healthcare Resources. Information and Statistics Division, Edinburgh (2002)
Gravelle, H., Sutton, M., Morris, S., Windmeijer, F., Leyland, A., Dibben, C., Muirhead, M.: Modelling supply and demand influences on the use of health care: implications for deriving a ‘needs-based’ capitation formula. Health Econ. 12, 985–1004 (2003)
Gravelle, H., Morris, S., Sutton, M.: Economic studies of equity in the consumption of health care. In: Jones, A. (ed.) The Elgar Companion to Health Economics. Edward Elgar, Cheltenham (2006)
van Doorslaer, E., Koolman, X., Jones, A.M.: Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 13(7), 629–647 (2004)
Morris, S., Sutton, M., Gravelle, H.: Inequity and inequality in the use of health care in England: an empirical investigation. Soc. Sci. Med. 60, 1251–1266 (2005)
Chatterjee, S., Hadi, A.S.: Regression Analysis by Example, 4th edn. Wiley, New York (2006)
The Centre for Innovation in Primary Care: What Do Practice Nurses Do? A Study of Roles, Responsibilities and Patterns of Work. The Centre for Innovation in Primary Care, Sheffield (2002)
Asthana, S., Halliday, J., Gibson, A.: Social exclusion and social justice: a rural perspective on resource allocation. Policy Polit. 37(2), 201–214 (2009)
Branson, C., Badger, B., Dobbs, F.: Patient satisfaction with skill mix in primary care: a review of the literature. Prim. Health Care Res. Dev. 4, 329–339 (2003)
Van Doorslaer, E., Wagstaff, A., van der Burg, T., et al.: Equity in the delivery of health care in Europe and the US. J. Health Econ. 19, 553–583 (2000)
Alexander, Z.: Study of Black, Asian and Ethnic Minority Issues. The Department of Health, London (1999)
Benzeval, M., Judge, K.: The determinants of hospital utilisation: implications for resource allocation in England. Health Econ. 32, 105–116 (1994)
Benzeval, M., Judge, K.: Access to health care in England: continuing inequalities in the distribution of GPs. J. Public Health Med. 18, 33–40 (1996)
Smaje, C., Le Grand, J.: Ethnicity, equity and the use of health services in the British NHS. Soc. Sci. Med. 45, 485–496 (1997)
Sutton, M., Carr-Hill, R., Gravelle, H., Rice, N.: Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation? Soc. Sci. Med. 49, 867–878 (1999)
Abásolo, I., Manning, R., Jones, A.: Equity in utilization of and access to public-sector GPs in Spain. Appl. Econ. 33, 349–364 (2001)
Acknowledgments
Earlier versions of this paper were presented at the Health Economists’ Study Group meeting at Brunel University in September 2007 and at the 28th Spanish Health Economics Association Conference in May 2008. We would like to thank Stirling Bryan and other participants at the meetings for their helpful comments.
Conflict of interest statement
LVT’s post is funded by an MRC Capacity Building Studentship in Health Economics. SM’s post is funded by the UCLH/UCL Comprehensive Biomedical Research Centre. The views expressed in the paper are not necessarily those of the funders.
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Vallejo-Torres, L., Morris, S. Factors associated with the use of primary care services: the role of practice nurses. Eur J Health Econ 12, 373–381 (2011). https://doi.org/10.1007/s10198-010-0251-5
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DOI: https://doi.org/10.1007/s10198-010-0251-5