Characterizing nurse practitioner practice by sampling patient encounters: An APRNet study

Purpose: The purpose of this study was to characterize nurse practitioners’ (NPs’) practice by using reports of patient encounters to more accurately reflect practice patterns than has been previously performed. This study was part of a larger primary care practice survey by a consortium of 20 practice-based research networks (PBRNs). Therefore, comparisons, when appropriate, were also made between this network of NPs (Advanced Practice Registered Nurse Network, APRNet) and the other 19 physician-run research networks. Data sources: A descriptive survey was developed by the 20 PBRN consortium under grants from the Agency for Healthcare Research and Quality. The consortium’s goal was to collect primary care data over a 6-month period and to document and compare primary care practice in the United States. The data were collected immediately following members’ encounters with patients rather than from billing spreadsheets. Nineteen PBRNs may have had NPs in the practices that comprised their networks. However, the data from these NPs were collected under the study ID numbers of the physician owners of each practice. APRNet, therefore, was the sole research network comprised exclusively of NPs who collected and reported data under their own study ID numbers. Conclusions: Acute health problems comprised 45% of all episodes treated by NPs compared to 30% of episodes for exacerbations of chronic conditions and 24.5% for nonillness and health promotion visits. In addition, our findings suggest that NPs provide counseling in 84% (vs. 61% for physicians) of their primary care visits, regardless of the reason for visit, and the type of counseling varies by the type of NP. Implications for practice: Despite many studies on the comparability and outcomes of NP practice, the need to identify, clarify, and document the practices of NPs in primary care settings remains. The present survey provides an important and useful first step in providing a systematic way to characterize these practices through a survey of APRNs immediately following their patient encounters.