Impact of nurse practitioners in primary care on patients with chronic diseases in rural and underserved areas: A systematic review

BACKGROUND: Ageing, multimorbidity, and workforce shortages increasingly limit access to primary healthcare, especially in rural and underserved areas. OBJECTIVES: To document impact of nurse practitioners (NPs) in primary care on patients with chronic diseases. METHODS: Searches were conducted in Medline, EMBASE, CINAHL, and CENTRAL (March 1978-October 2023). This systematic review followed MECIR and PRISMA guidelines (PRISMA 2020 checklist: EQUATOR Network) with SWiM used as a PRISMA extension due to the lack of meta-analysis. The focus was on NPs' roles in chronic disease management and primary care in underserved or remote areas, excluding mental health, cancer, and dental care. RESULTS: Among 3,684 citations, 25 studies were selected, including 10 RCT. NPs may improve access to primary care and chronic disease management, particularly in underserved areas. Although not all studies directly compared NPs to traditional models, they were most often assessed against General Practitioners (GPs) alone. Seven studies also evaluated collaborative NP-GP models versus GP-only care. Patient satisfaction was generally higher with NPs, possibly due to longer consultations and greater patient education. Clinical and biological outcomes were often comparable between NPs and GPs, with the best results in collaborative models, which were also associated with higher costs. CONCLUSION: NPs may enhance access to care, particularly for vulnerable populations. Higher patient satisfaction may be linked to longer consultations and patient education. While clinical outcomes were comparable to those of GPs, collaborative models yielded the best results, though potentially at a higher cost.