Roles and Outcomes of Advanced Practice Nurses in Thailand: A Systematic Review
TL;DR
Evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand, but these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated.
Abstract
Background and Objectives: Advanced practice nurses (APNs) play an increasingly important role in improving healthcare quality and outcomes. This systematic review synthesized evidence on APN roles and healthcare outcomes in Thailand. Methods: The review protocol was prospectively registered in PROSPERO (CRD420261331793). Four databases (PubMed, CINAHL, Scopus, and Thai Journals Online) were searched from inception to January 2026. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the Mixed Methods Appraisal Tool (MMAT, 2018) for mixed-methods studies and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental, analytical cross-sectional, and qualitative studies. A narrative synthesis was undertaken because of methodological heterogeneity. Results: Twenty studies were included, comprising eight quasi-experimental studies, six cross-sectional studies, four mixed-methods studies, one retrospective study, and one qualitative descriptive study. APNs performed diverse roles, including direct clinical care, care coordination, consultation, patient education, mentoring, and implementation of evidence-based practice. APN-led models of care were associated with favorable clinical outcomes, enhanced self-care and quality of life, increased patient and caregiver satisfaction, and reduced hospital length of stay and healthcare costs. Conclusions: The available evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand. However, these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated.