Comparable, but distinct: Perceptions of primary care provided by physicians and nurse practitioners in full and restricted practice authority states

Aims To understand patients’ and providers’ perceptions of primary care delivered by nurse practitioners (NPs) in the Veterans Affairs Healthcare System. Design Qualitative exploratory study (in convergent mixed‐methods design). Methods Semi‐structured interviews in 2016 with primary care providers and patients from facilities in states with full and restricted practice authority for NPs. Patient sample based on reassignment to: (a) a NP; or (b) a different physician following an established physician relationship. Data were analysed using content analysis. Results We interviewed 28 patients, 17 physicians and 14 NPs. We found: (a) NPs provided more holistic care than physicians; (b) patients were satisfied with NPs; and (c) providers’ professional experience outweighed provider type. Conclusions Patients’ preferences for NPs (compared with prior physicians) contributed to perceptions of patient centredness. Similarities in providers’ perceptions suggest NPs and physicians are both viable providers for primary care. Impact Nurse Practitioners (NPs): practice authority Veterans Affairs Health care: nurse practitioners will continue to be a viable resource for primary care delivery United States Health care: challenges notions patients may not be satisfied with care provided by NPs and supports expanding their use to provide much‐needed access to primary care services; expanding Full Practice Authority would allow states to provide acceptable primary care without diminishing patient or provider experiences 摘要 目标 了解患者和医疗机构对退伍军人医疗保健系统中护理师提供初级护理的看法。 设计 探索性的定性研究(收敛混合方法设计)。 方法 2016年进行的半结构化访谈,采访了州内拥有护理师的全科和非全科执业机构的初级护理提供者和患者。重新分配患者样本:(a) 一名护理师;或(b)确立医生关系的另一名医生。采用内容分析法对数据进行分析。 结果 我们采访了28名患者,17名医生和14名护理师。我们发现:(a)护理师比医生提供的护理更全面;(b)患者对护理师感到满意;(c)医疗机构的专业经验的权重比医疗机构类型的权重更大。 结论 患者对护理师的偏好(与以前的医生相比)有助于建立以患者为中心的认知。提供者的观念类似,表明护理师和医生都是可行的初级护理提供者。 影响 •护理师:执业机构 •退伍军人医疗保健系统:护理师将继续作为提供初级护理服务的可用资源。 •美国卫生保健:挑战观念 患者可能不满意由护理师提供的护理,其会支持扩大使用范围,以提供急需的初级保健服务;扩大全科执业机构将使各州能够提供可接受的初级保健服务,而不会减弱患者或提供者的体验。