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Nurse Practitioner-Physician Comanagement of Patients in Primary Care.

  • Norful, Allison A1, 2
  • Ye, Siqin3, 4
  • Van der-Biezen, Mieke5, 6
  • Poghosyan, Lusine1
  • 1 1 Columbia University School of Nursing, New York, NY, USA.
  • 2 2 Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA.
  • 3 3 Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
  • 4 4 Columbia Doctors, New York, NY, USA.
  • 5 5 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. , (Netherlands)
  • 6 6 Scientific Center for Quality of Health care, IQ Health care, Radboud University Medical Center, Nijmegen, the Netherlands. , (Netherlands)
Published Article
Policy, politics & nursing practice
Publication Date
Dec 05, 2018
DOI: 10.1177/1527154418815024
PMID: 30517047


Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician-physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)-physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP-physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP-physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP-physician comanagement should be supported in clinical practice.

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