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Table 3 Summary of included studies with regard to complexity

From: Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review

SourceUseContext
Qualitative Study Design
 O’Brien et al. [23], UScomplex medical issuesGPs take leadership with complex medical issues while NPs have a different focus.
 Parker et al. [24], AUcomplex medical concernsGPs care for more complex medical conserns while NPs treat minor ailments.
 O’Malley et al. [25], UScomplex (care) needscomplex patientsOffloading tasks enables physicians to care for patients with complex needs. NCM also work with complex patients.
 Van der Biezen et al. [26], NLcomplex patientscomplex caseloadscomplex complaintsNPs enable GPs to focus on and have more time for complex patients leading to a more complex caseload while NPs treat less complex patients.
 Lovink et al. [27], NLcomplex care complex patientsGPs and NPs report that NPs are competent to perform geriatric assessments in older adults with complex care needs. However, the introduction of NPs in general practice means that GPs focus on more complex patients.
 Boman et al. [28], NO/FIcomplex care needsNPs act as case managers especially for patients with complex care needs and comorbidity.
 Côté et al. [29], CAcomplex patientsGPs report their case loads including more medically complex patients upon collaborating with NPs who care for less medically vulnerable patients.
 Pelletier et al. [30], CAcomplex health situations complex casesNPs enable GPs to manage more chronically ill patients while treating minor medical problems.
Quantitative Study Designs
 Ohman-Strickland et al. [31], UScomplex patientsPractices with NPs could improve efficiency and individualisation of care because physicians could care for complex patients while NPs could introduce preventative approaches.
 Everett et al. [32], UScomplexity of populationsPopulations served by NPs and doctors do not differ in complexity.
 Subramanian et al. [33], USdecision-making complexity complex patientsNPs working independently with delayed physician supervision care for patients with high decision-making complexity.
 Yarnall et al. [34], UScomplex medical care issuesNPs can expand amount of time available for patients and free up physician’s time for complex medical care.
 Chung et al. [35], UScomplex conditions complex patientsNPs enabled practices to contentrate on and provide appropriate care to complex patients thus reducing the number of referrals to specialists.
 Mian et al. [36], CAcomplex careFPs refer patients to NPs who serve as substitutes for less complex care.
 Morgan et al. [37], UScomplexity scorespatient complexity medically complex complex patientsDespite NPs and physicians having a similar complexity score, indicating NPs do treat complex patients, according to patient encounters physicians treat slightly more complex patients.
 Donelan et al. [38], UScomplex cases complex chronic conditionsDouble the amount of physicians compared to NPs report that physicians treat more complex cases. A third of physicians report that NPs provide services for complex conditions.
 Everett et al. [39], UScomplex patientsNPs in a supplementary role who do not treat complex patients have similar or better outcomes compared to physician-only care. Whereas NPs in a supplementary role who do treat complex patients have worse outcomes than physician-only care.
 Everett et al. [40], USsocially complex patients clinical complexity complex patientsCompared to physicians, NPs as usual providers treat more socially complex patients and similar clinical complexity. However, NPs as usual providers refer patients to physicians significantly more often than the reverse.
 Dahrouge et al. [41], CAcomplex medical conditions medical complexity medically complex patients socially complex patientsFPs care for patients with more complex medical conditions. NPs care for patients with less medical complexity to minimise consultations with family physicians. Compared to FPs, NPs treat more socially complex patients.
 Ku et al. [42], UScomplexity of care complex visits complex conditionsPysicians are more involved in complex visits and overall involved in the care of patients with complex conditions compared to NPs.
 Kuo et al. [43], USmedically complex individualsNPs recognise limitations when treating medically complex individuals. Overall NPs may treat less medically complex patients than PCPs.
 Park [44], UScomplex casesNPs in practices can increase accommodation and care coordination of patients because the physician’s time is freed up for complex cases.
 Reckrey et al. [45], UScomplex medical and psychosocial needs complex care situations complex patientsTeam-based models of care are needed to treat complex medical and psychosocial needs. NPs take an enhanced role in the management of the most complex patients in team approach physician panels.
 Marcum et al. [46, 47], UScomplex patient panelsPCPs prescribe more medication on account of their patient panel being more compelx than that of NPs.
 Raji et al. [48], UScomplex health conditionsA team approach including NPs and MDs may be best for patients with complex health conditions.
 Van der Biezen et al. [49], NLminor ailments task complexityNPs treat a patient panel with minor ailments.
 D’Afflitti et al. [50], UScomplex patientsNPs cared reach out to medically and socially complex patients to engage them in care.
 Yang et al. [51], USmedical complexityNPs caring for diabetic patients in the VHA treat similar medical complexity as GPs.
 Morgan et al. [52], UScomplex patientsNPs provide care for medically complex patients without increasing costs.
Other Study Designs
 Fletcher et al. (mixed methods) [53], UScomplex patients complex cases complexity of patientsNPs can increase access for more patients and free up physician’s time for complex patients.
In physician’s opinion NPs can only treat complex cases under constant, direct physician supervision. In physician’s opinion NPs should treat low complexity patients.
 Dierick-van Daele et al. (mixed methods) [54], NLminor health problems complex careNPs should care for common complaints and minor health problems freeing up GP’s time for patients with chronic diseases and multimorbidity.
According to a direct quote from one GP complex care is best shared by a GP and a NP.
 Sustaita et al. (review) [55], UScomplex patientsNPs can free up physicians’ time by taking over routine tasks and allowing physicians to treat complex patients.
 Freund et al. (comparison) [56], NLcomplex presentations (minor illnesses)NPs in the Netherlands are responsible for clinical diagnosis and treatment of less complex presentations and chronic care management.
 Helms et al. (case study) [57], AUcomplex conditionscomplex chronic diseasesThe NP has his own caseload and receives referrals from other team members according to expertise and interest. The NP increased GP productivity by caring for patients with complex diseases.
 Bodenheimer & Bauer (perspective) [2, 58], UScomplex health care needsWhen GPs and NPs collaborate, GPs will lead the team caring for people with complex health care needs.
 Hunter et al. (mixed methods) [59], CAcomplex patientsNPs improve access for complex patients in an area short of primary care providers.
 Collins (mixed methods) [60], UKcomplex conditionsNPs treat a range from minor illness to complex conditions such as cancer.
  1. Sources: US United States, NL Netherlands, CA Canada
  2. Professionals: NP Nurse practitioner, GP General practitioner, FP Family physician, NCM Nurse care manager, PCP Primary care physician, MD Medical doctor