• Ruth Martin-Misener, Kelley Kilpatrick, Faith Donald, Denise Bryant-Lukosius, Jennifer Rayner, Ruta Valaitis, Nancy Carter, Patricia A Miller, Véronique Landry, Patricia Harbman, Renee Charbonneau-Smith, R James McKinlay, Erin Ziegler, Sarah Boesveld, and Alyson Lamb.
• School of Nursing, Dalhousie University, Box 15000, 5869 University Ave., Halifax, NS, B3H 4R2, Canada. Electronic address: ruth.martin-misener@dal.ca.
• Int J Nurs Stud. 2016 Oct 1; 62: 170-82.

ObjectivesTo identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings.DesignScoping review of the international published and grey literature.Data SourcesThe search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data.ResultsWe identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9-15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores.DiscussionThe measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture activities relevant to community-based primary health care nurse practitioners. Tools to measure all the components of these role are needed when determining panel/caseload size. Outcomes research is absent in the determination of panel/caseload size.ConclusionThere are few systems in place to track and measure community-based primary health care nurse practitioner activities. The development of such mechanisms is an important next step to assess community-based primary health care nurse practitioner productivity and determine patient panel/caseload size. Decisions about panel/caseload size must take into account the effects of nurse practitioner activities on outcomes of care.Copyright © 2016 Elsevier Ltd. All rights reserved.

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