For Off-Hours Care, Consider a Nurse Practitioner


Most patient care needs in the evening or night are neither complex nor urgent.

Most patient care needs in the evening or night are neither complex nor urgent.

When patients become ill, the need to work or care for a child often creates a dilemma. If their primary care providers close at 5 or 6 pm, they may struggle with the decision to leave work or find a substitute caregiver for their children. Or, they may wait to seek care later in the day. In the worst cases, the opportunity for early intervention is lost and the problem may worsen while care is delayed.

Retail health clinics staffed with nurse practitioners (NPs) and physician assistants may be the answer to this quandary.

The August 2016 issue of theJournal of Advanced Nursingpublished study results that once again validate the retail health provider’s value in off-hours services.

Investigators examined substituting general practitioners with NPs when care is needed in the evening hours. Although they looked at a UK national health system’s after-hours care, its implications for the United States are obvious.

Similar to general practitioners in the United States, those in the United Kingdom face heavy workloads that spill over into off-hours. It’s believed that general practitioners who work exceedingly long hours are frazzled and tired, which may lead to substandard care.

The researchers looked at data from one general practitioner organization that had 12,092 patients on its rolls. One team included 5 general practitioners, while a second team—the experimental team—comprised an NP and 4 general practitioners. The teams saw the same number of patients.

In the mixed physician-NP team, the NP handled 16.3% of patients successfully. Each of the physicians saw approximately 21% of patients. Patients who were infants, who were older than 64 years, who were sicker, or who had digestive, cardiovascular, or neurological complaints were more likely to be seen by a physician.

Nearly three-quarters of patients who presented late in the day when the practices were closing or closed were able to be seen by the NP. Patients with skin and respiratory complaints tended to be funneled into NP care.

General practitioners’ caseloads remained about the same, even when an NP fulfilled one care role.

NPs handled off-hours patient visits, with the majority of the complaints being acute minor illnesses, in a manner that was approximately the same as the care delivered by general practitioners. The authors hinted at an important point: many areas could benefit by increased use of NPs, such as those with shortages of general practitioners, locales with heavy off-hours needs, and communities where emergency care is misused for less-than-urgent health problems.

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