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Contandriopoulos D, Bertoni K, McCracken R, Hedden L, Lavergne R, Randhawa GK. Evaluating the cost of NP-led vs. GP-led primary care in British Columbia. Healthc Manage Forum 2024; 37:244-250. [PMID: 38291669 DOI: 10.1177/08404704241229075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC's Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.
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Affiliation(s)
| | | | - Rita McCracken
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
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McCullough K, Baker M, Bloxsome D, Crevacore C, Davies H, Doleman G, Gray M, McKay N, Palamara P, Richards G, Saunders R, Towell-Barnard A, Coventry LL. Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: A scoping review. J Clin Nurs 2024; 33:874-889. [PMID: 37953491 DOI: 10.1111/jocn.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
AIMS To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION Not required as the Scoping Review used publicly available information.
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Affiliation(s)
- Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Melanie Baker
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Hugh Davies
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Nilufeur McKay
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gina Richards
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
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McCullough K, Doleman G, Dunham M, Whitehead L, Porock D. Are remote health clinics primary health care focused? Validation of the Primary Health Care Engagement (PHCE) Scale for the Australian remote primary health care setting. Prim Health Care Res Dev 2024; 25:e3. [PMID: 38179608 PMCID: PMC10790365 DOI: 10.1017/s1463423623000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 01/06/2024] Open
Abstract
AIM To test and validate a measure of primary health care (PHC) engagement in the Australian remote health context. BACKGROUND PHC principles include quality improvement, community participation and orientation of health care, patient-centred continuity of care, accessibility, and interdisciplinary collaboration. Measuring the alignment of services with the principles of PHC provides a method of evaluating the quality of care in community settings. METHODS A two-stage design of initial content and face validity evaluation by a panel of experts and then pilot-testing the instrument via survey methods was conducted. Twelve experts from clinical, education, management and research roles within the remote health setting evaluated each item in the original instrument. Panel members evaluated the representativeness and clarity of each item for face and content validity. Qualitative responses were also collected and included suggestions for changes to item wording. The modified tool was pilot-tested with 47 remote area nurses. Internal consistency reliability of the Australian Primary Health Care Engagement scale was evaluated using Cronbach's alpha. Construct validity of the Australian scale was evaluated using exploratory factor analysis and principal component analysis. FINDINGS Modifications to suit the Australian context were made to 8 of the 28 original items. This modified instrument was pilot-tested with 47 complete responses. Overall, the scale showed high internal consistency reliability. The subscale constructs 'Quality improvement', 'Accessibility-availability' and 'population orientation' showed low levels of internal consistency reliability. However, the mean inter-item correlation was 0.31, 0.26 and 0.31, respectively, which are in the recommended range of 0.15 to 0.50 and indicate that the items are correlated and are measuring the same construct. The Australian PHCE scale is recommended as a tool for the evaluation of health services. Further testing on a larger sample may provide clarity over some items which may be open to interpretation.
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Affiliation(s)
- Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia
| | - Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia
| | - Melissa Dunham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia
| | - Davina Porock
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia
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Etemadi S, Dehnavieh R, Pour MH, Mehri M, Behzadi A. The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:59-69. [PMID: 38694855 PMCID: PMC11058379 DOI: 10.18502/ijph.v53i1.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/14/2023] [Indexed: 05/04/2024]
Abstract
Background In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis. Methods We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023. Results The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model. Conclusion Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure.
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Affiliation(s)
- Sina Etemadi
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Marjan Hedayati Pour
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Mehri
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Goh LH, Szücs A, Siah CJR, Lazarus MA, Tai ES, Valderas JM, Young DYL. Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study. BMC Health Serv Res 2023; 23:1445. [PMID: 38124081 PMCID: PMC10734143 DOI: 10.1186/s12913-023-10310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) remains an important chronic condition worldwide requiring integrated patient-centred care as advocated by the Chronic Care Model (CCM). The Primary Care Networks (PCNs) in Singapore organise general practitioners (GPs) with nurses and care coordinators to deliver team-based care for patients with chronic conditions. This study examined the quality of care in the PCNs as defined by the CCM from the patients' perspective. METHODS This study followed a cross-sectional convergent mixed-method design with T2D patients across three PCN types (GP-led, Group, and Cluster). The Patient Assessment of Chronic Illness Care (PACIC, range 1-5) was completed by a convenience sample of 343 patients. Multivariate linear regression was performed to estimate the associations between patient and service characteristics and PACIC summary score. Twenty-four participants were purposively recruited for interviews on the experienced care until thematic saturation was reached. Quantitative and qualitative data were collected concurrently and independently. Integration occurred during study design and data analysis using the CCM as guidance. Quantitative and qualitative results were compared side-by-side in a joint comparison table to develop key concepts supported by themes, subthemes, and patients' quotes. RESULTS The PACIC mean summary score of 3.21 for 343 patients evidenced that some have received CCM consistent care in the PCNs. Being younger and spending more time with the GP were associated with higher PACIC summary scores. PACIC summary scores did not differ across PCN types. The 24 patients interviewed in the qualitative study reported receiving team-based care, nurse services, good continuity of care, as well as patient-centred care, convenient access, and affordable care. Key concepts showed that integrated care consistent with the CCM was sometimes received by patients in the PCNs. Patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling were sometimes received by patients, while follow-up/coordination was generally not received. CONCLUSIONS Patients with T2D from the Singapore Primary Care Networks received integrated care consistent with the Chronic Care Model, particularly in patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling. Follow-up/coordination needed improvement to ensure higher quality of diabetes care.
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Affiliation(s)
- Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Anna Szücs
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chiew Jiat Rosalind Siah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, level 2, 10 Medical Drive, Singapore, 117597, Singapore
| | - Monica A Lazarus
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jose M Valderas
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Doris Yee Ling Young
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
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