Primary Health Care Provided to the Elderly by a Nurse Practitioner/Physician Team: Analysis of Cost Effectiveness†

Abstract

ABSTRACT An experimental design was used to compare the delivery of primary care by two health manpower patterns—the Physician Only (PO) and the Adult Health Nurse Practitioner/Physician (NP/P) Team. The study group consisted of 167 patients in three subgroups (Ambulatory, Homebound, and Nursing Home). The dependent variables were effectiveness and efficiency. Effectiveness was measured by the Goal Attainment Scale. Efficiency was determined by measuring the operational use and cost of the primary and supportive systems for health care delivery. A cost‐effectiveness model was used to facilitate the comparison between the two approaches to primary care. Scientific hypotheses related the measures of the dependent variables to the levels of the independent variable. The conclusions of the study were: 1) The NP/P Team is as effective as the PO but substantially more efficient in its operational use of the systems for health care delivery; 2) Ambulatory patients can make a positive change in the achievement of their health care goals with efficient use of the health care system, if they receive their care on a PO basis; 3) Homebound patients can make a positive change in such achievement if they receive their care from a NP/P Team; and 4) Nursing Home patients can make a positive change in such achievement whether they receive their care from the PO or from the NP/P Team.