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Braun-Inglis C, Williams EL, Macchiaroli A, Denicoff A, Gerber DE. Better Late Than Never: Fully Incorporating Oncology Advanced Practice Providers Into Cancer Clinical Trials. JCO Oncol Pract 2022; 18:729-732. [PMID: 35960907 PMCID: PMC9653202 DOI: 10.1200/op.22.00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Christa Braun-Inglis
- University of Hawaii School of Nursing and Dental Hygiene and University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alyssa Macchiaroli
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Denicoff
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Benito-Ruiz E, Sánchez-Recio R, Alijarde-Lorente R, Iguacel I, Pérez-Corral M, Martín de Vicente CL, Jiménez-Olmos A, Gasch-Gallén Á. The Nurse's Role in Educating Pediatric Patients on Correct Inhaler Technique: An Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074405. [PMID: 35410092 PMCID: PMC8998829 DOI: 10.3390/ijerph19074405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023]
Abstract
The prevalence of pediatric respiratory diseases in Spain is 23%. Inhalation is the preferred route of administration but there are frequent errors in the performance of the inhalation technique leading a poor control of the disease. The aim of this research was to detect errors in the execution of the inhalation technique at a Pediatric Pulmonology Unit in a hospital of Aragón (Spain). In order to improve the administration of inhaled medication, an educational intervention for 1 year by nursing was conducted. This interventional study, including children aged 1 to 15 years with an inhalation therapy and who attended the Pediatric Pulmonology Unit, was conducted between September 2017 and September 2018. Logistic Regression models were conducted in SPSS. This study involved 393 children (61.1% boys). Before the intervention, 39.4% achieved a correct inhalation technique increasing up to 62.1% after the intervention. Those who had their first visit to the Unit, young children and girls had a higher risk of incorrect performance than those with subsequent visits, older children, and boys, respectively. The most common errors in the inhalation technique were not performing adequate apnoea after inhaling and not rinsing the mouth at the end of the procedure. The education given by nurses to pediatric patients improved the inhalation technique, achieving better control of the disease and use of the health system.
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Affiliation(s)
- Eva Benito-Ruiz
- Pediatric Intensitive Care Unit, Miguel Servet Hospital, 50009 Zaragoza, Spain; (E.B.-R.); (M.P.-C.); (A.J.-O.)
- Physiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (R.S.-R.); (Á.G.-G.)
| | - Raquel Sánchez-Recio
- Physiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (R.S.-R.); (Á.G.-G.)
| | | | - Isabel Iguacel
- Physiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (R.S.-R.); (Á.G.-G.)
- Correspondence:
| | - María Pérez-Corral
- Pediatric Intensitive Care Unit, Miguel Servet Hospital, 50009 Zaragoza, Spain; (E.B.-R.); (M.P.-C.); (A.J.-O.)
| | | | - Ainhoa Jiménez-Olmos
- Pediatric Intensitive Care Unit, Miguel Servet Hospital, 50009 Zaragoza, Spain; (E.B.-R.); (M.P.-C.); (A.J.-O.)
| | - Ángel Gasch-Gallén
- Physiatry and Nursing Department, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (R.S.-R.); (Á.G.-G.)
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3
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Kinchen E. Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making. J Holist Nurs 2021; 40:326-335. [PMID: 34894839 DOI: 10.1177/08980101211062704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants' views on the holistic attributes of their care. A convenience sample of NPs (n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to "what matters most" to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify "lack of time" to incorporate or practice holistic care as a barrier.
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4
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Daley EM, Thompson EL, Beckstead J, Driscoll A, Vamos C, Piepenbrink RP, Desch J, Merrell L, Richardson Cayama MB, Owens H, Lovett SM. Discussing HPV and oropharyngeal cancer in dental settings: gender and provider-type matter. Hum Vaccin Immunother 2021; 17:5454-5459. [PMID: 34890526 PMCID: PMC8904021 DOI: 10.1080/21645515.2021.1996809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and the leading cause of oropharyngeal cancer (OPC), an oral cancer most often identified by dental providers. Given the rise in HPV-associated OPC and recent Food and Drug Administration (FDA) approval of the HPV vaccine to prevent OPC, dental providers have a unique role in HPV prevention. This study assessed US adults' comfort levels discussing HPV and OPC with dental providers. An online survey platform was used to recruit a nationally representative sample of US adults (n = 300). The questionnaire assessed participants' knowledge, acceptability, and comfort discussing HPV-related topics with dental providers. SPSS 24 was utilized for data analyses. In general, participants reported feeling comfortable discussing HPV and OPC with dental providers. Participants reported feeling more comfortable with dentists than dental hygienists when discussing (t = 2.85, p < .01) and receiving recommendations about the HPV vaccine (t = 2.09, p < .05). Participants were less comfortable discussing HPV as a risk factor for OPC compared to non-HPV related risk factors (t = 2.94, p < .01). Female participants preferred female providers, whereas male participants had no preference. Previous research has indicated dental providers recognize their role in HPV prevention, but research is needed to understand patients' perceptions of dental providers' role in HPV prevention. Findings demonstrate that US adults are comfortable discussing HPV and OPC with dental providers, which may be key to OPC-HPV prevention. Future research is needed to facilitate HPV communication between patients and dental providers.
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Affiliation(s)
- Ellen M. Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Annelise Driscoll
- Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Cheryl Vamos
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Jill Desch
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Laura Merrell
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA
| | | | - Heather Owens
- College of Public Health, University of South Florida, Tampa, FL, USA
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5
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Officer TN, McBride-Henry K. Perceptions of underlying practice hierarchies: Who is managing my care? BMC Health Serv Res 2021; 21:911. [PMID: 34479554 PMCID: PMC8414878 DOI: 10.1186/s12913-021-06931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of new health professional roles, such as that of the nurse practitioner and pharmacist prescriber in primary health care can lead to changes in health service delivery. Consumers, having used these roles, often report high satisfaction. However, there is limited knowledge of how these individuals position nurse practitioner and pharmacist prescriber roles within existing practice structures. METHODS Semi-structured interviews were conducted with 21 individuals receiving services from these practitioners in New Zealand primary health care. Interviews were recorded and transcribed verbatim for thematic analysis. RESULTS Participant views reflect established practice hierarchies, placing advanced practitioners 'below' general practitioners. Participants are unable to articulate what it was about these practitioners that meant they operated at lower tiers and often considered practitioners to act as 'their doctor'. They also highlight structural barriers impairing the ability of these providers to operate within their full scope of practice. CONCLUSIONS While seeing value in the services they receive, consumers are often unable to position nurse practitioner and pharmacist prescriber roles within health system contexts or to articulate how they value their practitioner's skills. Embedded structural barriers may be more visible to consumers than their interactions with the health system suggest. This may influence peoples' ability to receive intended or optimal health services. Consumer 'health professional literacy' around the functions of distinct health practitioners should be supported so that they may make informed service provision choices.
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Affiliation(s)
- Tara N Officer
- Health Services Research Centre, Victoria University of Wellington, PO Box 600, Pipitea Campus, Wellington, New Zealand
| | - Karen McBride-Henry
- School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, PO Box 600, Newtown Campus, Wellington, New Zealand
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6
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Lopatina E, Marshall DA, Le Clercq SA, Noseworthy TW, Suter E, De la Rossa Jaimes C, Lauf AM, Mosher DP, Barber CEH. Nurse-Led Care for Stable Patients with Rheumatoid Arthritis: Quality of Care in Routine Practice Compared to the Traditional Rheumatologist-Led Model. Rheumatol Ther 2021; 8:1263-1285. [PMID: 34236650 PMCID: PMC8380599 DOI: 10.1007/s40744-021-00339-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/16/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION This pragmatic non-inferiority study assessed quality of care within a nurse-led care (NLC) model for stable patients with rheumatoid arthritis (RA) compared to the traditional rheumatologist-led care (RLC) model. METHODS Data were collected through a chart review. Baseline demographic and clinical characteristics were compared using Chi-square test and t test. The primary outcome measure was the percentage of patients being in remission or low disease activity (R/LDA) with the Disease Activity Score (DAS-28) ≤ 3.2 at 1-year follow-up. Process measures included the percentages of patients with chart documentation of (1) comorbidity screening; (2) education on flare management, and (3) vaccinations screening. Outcomes were summarized using descriptive statistics. RESULTS Each group included 124 patients. At baseline, demographic and clinical characteristics were comparable between the groups for most variables. Exceptions were the median (Q1, Q3) Health Assessment Questionnaire Disability Index scores [0 (0, 0.25) in NLC and 0.38 (0, 0.88) in RLC, p = 0.01], and treatment patterns with 3% of NLC and 38% of RLC patients receiving a biologic agent, p = 0.01. NLC was non-inferior to RLC with 97% of NLC and 92% of RLC patients being in R/LDA at 1-year follow-up. Patients in the NLC group had better documentation across all process measures. CONCLUSIONS This study provided real-world evidence that the evaluated NLC model providing protocolized follow-up care for stable patients with RA is effective to address patients' needs for ongoing disease monitoring, chronic disease management, education, and support.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C56, 3280 Hospital Drive NW , Calgary, AB, T2N 4Z6, Canada.
| | - Sharon A Le Clercq
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research, and Wellness Building (TRW), 3D14-B, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Esther Suter
- Faculty of Social Work, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Carolina De la Rossa Jaimes
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Anne Marie Lauf
- Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre (HSC), G-802A, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3AA20, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3AA20, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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7
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Ryder M, Jacob E, Hendricks J. An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. Int J Nurs Pract 2020; 26:e12901. [PMID: 33291184 DOI: 10.1111/ijn.12901] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
AIMS This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. BACKGROUND Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. DESIGN This study used a systematic integrative review by using Torraco's approach. DATA SOURCES Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. REVIEW METHODS A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. RESULTS Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. CONCLUSION The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,Department of Nursing, St. Vincent's University Hospital, Dublin, Ireland
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Joyce Hendricks
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia.,School of Nursing, Central Queensland University, Rockhampton, QLD, Australia
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8
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Understanding parent preferences for NHS paediatric allergy services. Clin Exp Allergy 2020; 50:1159-1165. [DOI: 10.1111/cea.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/04/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022]
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9
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Moldestad M, Greene PA, Sayre GG, Neely EL, Sulc CA, Sales AE, Reddy A, Wong ES, Liu CF. Comparable, but distinct: Perceptions of primary care provided by physicians and nurse practitioners in full and restricted practice authority states. J Adv Nurs 2020; 76:3092-3103. [PMID: 32875584 DOI: 10.1111/jan.14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Abstract
AIMS To understand patients' and providers' perceptions of primary care delivered by nurse practitioners (NPs) in the Veterans Affairs Healthcare System. DESIGN Qualitative exploratory study (in convergent mixed-methods design). METHODS Semi-structured interviews in 2016 with primary care providers and patients from facilities in states with full and restricted practice authority for NPs. Patient sample based on reassignment to: (a) a NP; or (b) a different physician following an established physician relationship. Data were analysed using content analysis. RESULTS We interviewed 28 patients, 17 physicians and 14 NPs. We found: (a) NPs provided more holistic care than physicians; (b) patients were satisfied with NPs; and (c) providers' professional experience outweighed provider type. CONCLUSIONS Patients' preferences for NPs (compared with prior physicians) contributed to perceptions of patient centredness. Similarities in providers' perceptions suggest NPs and physicians are both viable providers for primary care. IMPACT Nurse Practitioners (NPs): practice authority Veterans Affairs Health care: nurse practitioners will continue to be a viable resource for primary care delivery United States Health care: challenges notions patients may not be satisfied with care provided by NPs and supports expanding their use to provide much-needed access to primary care services; expanding Full Practice Authority would allow states to provide acceptable primary care without diminishing patient or provider experiences.
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Affiliation(s)
- Megan Moldestad
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - Preston A Greene
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - George G Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Emily L Neely
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - Christine A Sulc
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - Anne E Sales
- VHA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ashok Reddy
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Edwin S Wong
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Chuan-Fen Liu
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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10
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Dusseldorp LV, Groot M, Adriaansen M, Vught AV, Vissers K, Peters J. Impact of nurse practitioner care on patients with chronic conditions. J Am Assoc Nurse Pract 2020; 33:728-738. [DOI: 10.1097/jxx.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
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11
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Fuller A, Jenkins W, Doherty M, Abhishek A. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology (Oxford) 2020; 59:575-579. [PMID: 31410473 DOI: 10.1093/rheumatology/kez333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore patient satisfaction, gout knowledge, medication adherence and flares among participants receiving nurse-led or general practitioner (GP)-led care of gout in the Nottingham Gout Treatment Trial phase-II (NGTT-II). METHODS A total of 438 participants of NGTT-II were sent a questionnaire enquiring about gout knowledge, satisfaction with health-care practitioner, urate-lowering treatment being undertaken, and gout flares ⩾1 year after their final visit. Nurse-led care participants were asked about their preference for receiving gout treatment from either a GP or a nurse. RESULTS Completed questionnaires were returned by 82% of participants. Participants previously receiving nurse-led care reported greater satisfaction with health-care practitioner (P < 0.001), had better gout knowledge (P = 0.02), were more likely to be taking urate-lowering treatment [adjusted relative risk (95% CI) 1.19 (1.09, 1.30)], and self-reported fewer flares in the previous 12 months [median (inter-quartile range) 0 (0-0) vs 1 (0-3), P < 0.001] than those receiving GP-led care. Of participants receiving nurse-led care, 41-63% indicated preference for receiving gout treatment from a nurse, while only 5-20% indicated preference for receiving treatment from GPs. CONCLUSION The results of this study favour nurse-led care, involving individualized patient education and engagement and a treat-to-target strategy, in terms of patient acceptability, long-term adherence, and flares. Further research is required to evaluate the feasibility of implementing such a model of care in clinical practice.
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Affiliation(s)
- Amy Fuller
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
| | | | - Michael Doherty
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Academic Rheumatology, Nottingham, UK.,NIHR-BRC, University of Nottingham, Nottingham, UK
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12
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Cody R, Gysin S, Merlo C, Gemperli A, Essig S. Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review. BMC FAMILY PRACTICE 2020; 21:38. [PMID: 32066391 PMCID: PMC7025404 DOI: 10.1186/s12875-020-1089-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND General practitioner (GP) shortages and increasing demand for care led to the introduction of nurse practitioners (NPs) to primary care. Many concepts for task sharing among health professionals feature complexity. The aim of this narrative review was to examine how complexity is used as a factor for task allocation between GPs and NPs. METHODS According to the PRISMA statement, PubMed and CINAHL were searched systematically, and eligibility criteria were applied to detect literature concerning GPs and NPs in primary care and complexity in the context of task allocation. Relevant information was extracted, and a narrative analysis was performed. RESULTS Thirty-seven studies from seven countries were included, comprising quantitative, qualitative, and mixed methods. Complexity was used to describe patients, their needs, and health professionals' tasks. The understanding of the use of complexity as a factor for task allocation between NPs and GPs was based on the patient population (specific vs. unspecific), the setting (specific vs. unspecific), the numbers of health professionals involved (two vs. more than two), and the NP role (distinct model of care vs. no model). Despite similarities in these areas, the tasks which NPs perform range from providing minor to complex care. However, there is a slight trend towards NPs treating socially complex patients and GPs focusing on medically complex cases. CONCLUSION Complexity as a concept is prominent in primary care but remains broad and inconsistent as a factor for task allocation between NPs and GPs. This review can be used as a point of reference when practitioners are seeking methods for task allocation in a collaborative primary care setting.
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Affiliation(s)
- Robyn Cody
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland.
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
| | - Stefan Gysin
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
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13
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Druică E, Mihăilă V, Burcea M, Cepoi V. Combining Direct and Indirect Measurements to Assess Patients' Satisfaction with the Quality of Public Health Services in Romania: Uncovering Structural Mechanisms and Their Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010152. [PMID: 31878246 PMCID: PMC6981560 DOI: 10.3390/ijerph17010152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 12/31/2022]
Abstract
Introduction: Patients' satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients' feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients' satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients' perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares-path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients' experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients' satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients' satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.
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Affiliation(s)
- Elena Druică
- Centre for Research in Applied Behavioural Economics, Faculty of Business and Administration, University of Bucharest, 030018 Bucharest, Romania; (E.D.); (V.M.)
| | - Viorel Mihăilă
- Centre for Research in Applied Behavioural Economics, Faculty of Business and Administration, University of Bucharest, 030018 Bucharest, Romania; (E.D.); (V.M.)
| | - Marin Burcea
- Faculty of Business and Administration, University of Bucharest; 030018 Bucharest, Romania;
| | - Vasile Cepoi
- The Romanian Authority for Quality Assurance in Healthcare, 060022 Bucharest, Romania
- Correspondence:
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van den Brink GTWJ, Kouwen AJ, Hooker RS, Vermeulen H, Laurant MGH. An activity analysis of Dutch hospital-based physician assistants and nurse practitioners. HUMAN RESOURCES FOR HEALTH 2019; 17:78. [PMID: 31665010 PMCID: PMC6819603 DOI: 10.1186/s12960-019-0423-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management. STUDY DESIGN A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated. METHODS The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system. FINDINGS In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care. CONCLUSIONS NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.
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Affiliation(s)
- G T W J van den Brink
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Master Programs, HAN University of Applied Sciences, PO box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - A J Kouwen
- Radboud University Medical Center, PVI, Nijmegen, The Netherlands
| | - R S Hooker
- Health Policy Analyst, Ridgefield, WA, United States of America
| | - H Vermeulen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G H Laurant
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Institute of Nursing Studies, Nijmegen, The Netherlands
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15
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Raju SM, Raju RM, Shumskiy I, Morenz AM, Whitney KM, Vernacchio L, Fleegler EW. Are Pediatric House Calls the Future? Exploring Patient Perceptions of Home-Centered Health. Clin Pediatr (Phila) 2019; 58:1049-1055. [PMID: 31248269 DOI: 10.1177/0009922819859869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ravikiran M Raju
- 1 Harvard Medical School, Boston, MA, USA.,2 Boston Children's Hospital, Boston, MA, USA.,3 Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | - Louis Vernacchio
- 1 Harvard Medical School, Boston, MA, USA.,2 Boston Children's Hospital, Boston, MA, USA
| | - Eric W Fleegler
- 1 Harvard Medical School, Boston, MA, USA.,2 Boston Children's Hospital, Boston, MA, USA
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16
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Alexander D, Schnell M. Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health. JOURNAL OF HEALTH ECONOMICS 2019; 66:145-162. [PMID: 31220792 DOI: 10.1016/j.jhealeco.2019.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
We examine whether relaxing occupational licensing to allow nurse practitioners (NPs)-registered nurses with advanced degrees-to prescribe medication without physician oversight improves population mental health. Exploiting time-series variation in independent prescriptive authority for NPs from 1990 to 2014, we find that broadening prescriptive authority leads to improvements in self-reported mental health and decreases in mental health-related mortality. These improvements are concentrated in areas that are underserved by physicians and among populations that have difficulty accessing physician-provided care. Our results demonstrate that extending independent prescriptive authority to NPs can help mitigate physician shortages and extend care to disadvantaged populations.
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Vatnøy TK, Karlsen TI, Dale B. Exploring nursing competence to care for older patients in municipal in-patient acute care: A qualitative study. J Clin Nurs 2019; 28:3339-3352. [PMID: 31090955 DOI: 10.1111/jocn.14914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/20/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Abstract
AIM To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care. BACKGROUND An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance. DESIGN A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied. METHODS A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding. FINDINGS Two main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment." CONCLUSION Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success. RELEVANCE TO CLINICAL PRACTICE This study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.
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Affiliation(s)
- Torunn Kitty Vatnøy
- Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Tor-Ivar Karlsen
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Bjørg Dale
- Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway
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18
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Hohmeier KC, Desselle SP. Exploring the implementation of a novel optimizing care model in the community pharmacy setting. J Am Pharm Assoc (2003) 2019; 59:310-318. [DOI: 10.1016/j.japh.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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19
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Kuilman L, Jansen GJ, Middel B, Mulder LB, Roodbol PF. Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants. J Adv Nurs 2019; 75:1252-1262. [PMID: 30575080 DOI: 10.1111/jan.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/25/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore the direct and indirect effect of the personality meta-traits 'Stability' and 'Plasticity' on moral reasoning among nurse practitioners (NPs) and physician assistants (PAs). BACKGROUND Moral reasoning is influenced by being prone to moral disengagement and personality traits. Moral disengagement is observed among professionals in many fields, including healthcare providers. Moral disengagement is known to be provoked by environmental stressors and influenced by certain personality traits. DESIGN A cross-sectional approach was used including self-report questionnaires. METHODS A convenience sample of Dutch NPs (N = 67) and PAs (N = 88) was surveyed via online questionnaires between January and March 2015, using (a) the Defining Issues Test; (b) the BIG five inventory; and (c) the Moral Disengagement Scale. Structural equation modelling (SEM) was employed for estimating the construct validity of two meta-traits of personality and to test unidirectional influences on moral reasoning. RESULTS Only the Stability trait was a direct predictor of moral reasoning whereas both Stability and Plasticity were precursors of moral disengagement. Both personality meta-traits had statistically significant indirect effects on moral reasoning through a low level of moral disengagement. The influence of both personality traits on the level of moral reasoning was increased by strong self-censure on entering into morally disengaged interactions. CONCLUSION The personality meta-trait 'Stability' is an indicator of moral reasoning and is explained by a lower propensity to morally disengage among highly stable people. Although the meta-trait Plasticity exerts an indirect effect through moral disengagement on moral reasoning, it is not a direct indicator of moral reasoning.
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Affiliation(s)
- Luppo Kuilman
- Health Science - Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Physician Assistant Studies, College of Health and Human Service, Northern Arizona University, Phoenix, Arizona
| | - Gerard J Jansen
- Health Science - Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Berrie Middel
- Department of Health Sciences, Division of Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laetitia B Mulder
- Faculty of Economics and Business, Human Resource Management & Organisational Behaviour, University of Groningen, Groningen, The Netherlands
| | - Petrie F Roodbol
- Health Science - Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van Dusseldorp L, Groot M, Adriaansen M, van Vught A, Vissers K, Peters J. What does the nurse practitioner mean to you? A patient-oriented qualitative study in oncological/palliative care. J Clin Nurs 2019; 28:589-602. [PMID: 30129072 PMCID: PMC7380134 DOI: 10.1111/jocn.14653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/01/2018] [Accepted: 08/11/2018] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore what meaning patients associate with their experiences with a nurse practitioner (NP) in oncological or palliative care. BACKGROUND Care provided by NPs results in high patient satisfaction, mostly related to the assurance of continuity of care, and to receiving information and advice on coping with the disease. Research shows that health care provided by NPs equals the quality of care provided by physicians. Patients may be even more satisfied with care provided by NPs. Because patients' views have only been examined quantitatively, underlying experiences and meanings remain unclear. DESIGN A qualitative study from a phenomenological perspective. METHODS In 2017, seventeen outpatients aged 45-79 years, receiving oncological or palliative care, were interviewed in depth. Data were analysed by Colaizzi's seven-step method and by the Metaphor Identification Procedure. RESULTS Six fundamental themes emerged: the NP as a human (1) and as a professional (2), the NP providing care (3) and cure (4), NPs organising patient care (5) and the impact on patient's well-being (6). MIP analysis revealed six metaphors: NP means trust; is a travel aid; is a combat unit; is a chain; is a signpost; and is a technician. CONCLUSIONS NPs mean a lot to patients. NPs are valued as reliable, helpful and empathic. Patients feel empowered, at peace and in control as a result of the support, guidance and attention to them as a person as well as to aspects of the disease. Providing expert, integrated care makes patients feel safe and embraced in the NP's expertise. RELEVANCE TO CLINICAL PRACTICE This qualitative insight into patients' experiences will contribute to the body of knowledge on patients' perceptions of the treatment and support provided by NPs. It adds to the further development of the NPs' profession and education.
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Affiliation(s)
- Loes van Dusseldorp
- Radboud University Medical CentreExpertise Center for Pain and Palliative MedicineNijmegenThe Netherlands
| | - Marieke Groot
- Radboud University Medical CentreExpertise Center for Pain and Palliative MedicineNijmegenThe Netherlands
| | | | | | - Kris Vissers
- Radboud University Medical CentreExpertise Center for Pain and Palliative MedicineNijmegenThe Netherlands
| | - Jeroen Peters
- HAN University of Applied ScienceNijmegenThe Netherlands
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21
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Martin B, Alexander M. The Economic Burden and Practice Restrictions Associated With Collaborative Practice Agreements: A National Survey of Advanced Practice Registered Nurses. JOURNAL OF NURSING REGULATION 2019. [DOI: 10.1016/s2155-8256(19)30012-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
EXECUTIVE SUMMARY Nurse-led care is crucial to improving the effectiveness of cancer prevention, as demonstrated by research. However, barriers to nurse-led cancer preventive care are still prevalent. What are the challenges that impede nurses from providing effective preventive care? How can hospital leaders address these challenges to better engage nurses in preventive care? What should be the focal areas in terms of policy changes and training programs? This article explores those questions. We examine the difficulties nurses have encountered. We identify the barriers yet to be examined extensively. Finally, we propose that many barriers can be addressed through carefully designed nurses' training programs and substantial policy changes. Our data were collected from a Nurse Oncology Education Program survey that included questions on perceived oncology knowledge, current cancer-related preventive practices, and barriers to preventive practices. We identified the barriers for the nurse population studied and opportunities to overcome these barriers.
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Contandriopoulos D, Perroux M, Cockenpot A, Duhoux A, Jean E. Analytical typology of multiprofessional primary care models. BMC FAMILY PRACTICE 2018; 19:44. [PMID: 29621992 PMCID: PMC5887224 DOI: 10.1186/s12875-018-0731-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/28/2018] [Indexed: 01/13/2023]
Abstract
Background There is only limited evidence to support care redefinition and role optimization processes needed for scaling up of a stronger primary care capacity. Methods Data collection was based on a keyword search in MEDLINE, EMBASE and CINAHL databases. Three thousand, two hundred and twenty-nine documents were identified, 1851 met our inclusion criteria, 71 were retained for full-text assessment and 52 included in the final selection. The analysis process was done in four steps. In the end, the elements that were identified as particularly central to the process of transforming primary care provision were used as the basis of two typologies. Results The first typology is based on two structural dimensions that characterize promising multiprofessional primary care teams. The first is the degree to which the division of tasks in the team was formalized. The second dimension is the centrality and autonomy of nurses in the care model. The second typology offers a refined definition of comprehensiveness of care and its relationship with the optimization of professional roles. Conclusions The literature we analyzed suggests there are several plausible avenues for coherently articulating the relationships between patients, professionals, and care pathways. The expertise, preferences, and numbers of available human resources will determine the plausibility that a model will be a coherent response that is appropriate to the needs and environmental constraints (funding models, insurance, etc.). The typologies developed can help assess existing care models analytically or evaluatively and to propose, prospectively, some optimal operational parameters for primary care provision.
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Affiliation(s)
- Damien Contandriopoulos
- School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, British-Columbia, V8W 2Y2, Canada.
| | - Mélanie Perroux
- Faculty of Nursing, Université de Montréal, C.P. 6128 succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Aurore Cockenpot
- Faculty of Nursing, Université de Montréal, C.P. 6128 succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, C.P. 6128 succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Emmanuelle Jean
- School of Nursing, Université du Québec à Rimouski, 300, allée des Ursulines, C. P. 3300, succ. A, Rimouski, Québec, G5L 3A1, Canada
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van Hassel D, van der Velden L, de Bakker D, Batenburg R. Age-related differences in working hours among male and female GPs: an SMS-based time use study. HUMAN RESOURCES FOR HEALTH 2017; 15:84. [PMID: 29258573 PMCID: PMC5735885 DOI: 10.1186/s12960-017-0258-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In several countries, the number of hours worked by general practitioners (GPs) has decreased, raising concern about current and impending workforce shortages. This shorter working week has been ascribed both to the feminisation of the workforce and to a younger generation of GPs who prefer more flexible working arrangements. There is, however, limited insight into how the impact of these determinants interact. We investigated the relative importance of differences in GPs' working hours in relation to gender, age, and employment position. METHODS An analysis was performed on real-time monitoring data collected by sending SMS text messages to 1051 Dutch GPs, who participated during a 1-week time use study. We used descriptive statistics, independent sample t-tests, and one-way ANOVA analysis to compare the working time of different GP groups. A path analysis was conducted to examine the difference in working time by gender, age, employment position, and their combinations. RESULTS Female GPs worked significantly fewer hours than their male peers. GPs in their 50s worked the highest number of hours, followed by GPs age 60 and older. GPs younger than 40 worked the lowest number of hours. This relationship between working hours and age was not significantly different for women and men. As shown by path analysis, female GPs consistently worked fewer hours than their male counterparts, regardless of their age and employment position. The relationship between age and working hours was largely influenced by gender and employment position. CONCLUSIONS The variation in working hours among GPs can be explained by the combination of gender, age, and employment position. Gender appears to be the most important predictor as the largest part of the variation in working hours is explained by a direct effect of this variable. It has previously been reported that the difference in working hours between male and female GPs had decreased over time. However, our findings suggest that gender remains a critical factor for variation in time use and for policy instruments such as health workforce planning.
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Affiliation(s)
- Daniël van Hassel
- NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- CAOP, P.O. Box 556, 2501 CN Den Haag, The Netherlands
| | - Lud van der Velden
- NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Dinny de Bakker
- NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Tranzo, Scientific Centre for Transformation in Care and Welfare, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Ronald Batenburg
- NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Eriksson I, Lindblad M, Möller U, Gillsjö C. Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse. Int J Nurs Pract 2017; 24. [PMID: 29071766 PMCID: PMC5813192 DOI: 10.1111/ijn.12603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. AIM To describe patients' experiences of health care provided by an APN in primary health care. METHODS An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. RESULTS The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. CONCLUSION The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context.
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Affiliation(s)
- Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Monica Lindblad
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
| | | | - Catharina Gillsjö
- School of Health and Education, University of Skövde, Skövde, Sweden.,College of Nursing, University of Rhode Island, Kingston, RI, USA
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Klemenc-Ketis Z, Poplas-Susič A. Are characteristics of team members important for quality management of chronic patients at primary care level? J Clin Nurs 2017; 26:5025-5032. [PMID: 28793377 DOI: 10.1111/jocn.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To determine the possible associations between higher levels of selected quality indicators and the characteristics of providers. BACKGROUND In 2011, an ongoing project on a new model of family medicine practice was launched in Slovenia; the family physicians' working team (a family physician and a practice nurse) was extended by a nurse practitioner working 0.5 full-time equivalents. This was an example of a personalised team approach to managing chronic patients. METHODS We included all family medicine practices in the six units of the Community Health Centre Ljubljana which were participating in the project in December 2015 (N = 66). Data were gathered from automatic electronic reports on quality indicators provided monthly by each practice. We also collected demographic data. RESULTS There were 66 family medicine teams in the sample, with 165 members of their teams (66 family physicians, 33 nurse practitioners and 66 practice nurses). Fifty-six (84.4%) of the family physicians were women, as were 32 (97.0%) of the nurse practitioners, and 86 (95.5%) of the practice nurses. Multivariate analysis showed that a higher level of the quality indicator "Examination of diabetic foot once per year" was independently associated with nurse practitioners having attended additional education on diabetes, duration of participation in the project, age and years worked since graduation of nurse practitioners, working in the Center unit and not working in the Bezigrad unit. CONCLUSIONS Characteristics of team members are important in fostering quality management of chronic patients. Nurse practitioners working in new model family practices need obligatory, continuous professional education in the management of chronic patients. RELEVANCE TO CLINICAL PRACTICE The quality of care of chronic patients depends on the specific characteristics of the members of the team, which should be taken into account when planning quality improvements.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Community Health Centre Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Chouinard V, Contandriopoulos D, Perroux M, Larouche C. Supporting nurse practitioners' practice in primary healthcare settings: a three-level qualitative model. BMC Health Serv Res 2017. [PMID: 28651529 PMCID: PMC5485609 DOI: 10.1186/s12913-017-2363-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners’ integration. This study’s main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner’s practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. Methods This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. Results This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Conclusions Based on these findings, we suggest that support practices should be adapted to each organization’s environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2363-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Véronique Chouinard
- University of Montreal Hospital Centre (CHUM), University of Montreal Public Health Research Institute (IRSPUM), C.P. 6128 succ. Centre-Ville, Montreal, Quebec, H3C 3J7, Canada
| | - Damien Contandriopoulos
- University of Montreal, Faculty of Nursing, University of Montreal Public Health Research Institute (IRSPUM), Pavillon Marguerite-d'Youville, 2375, chemin de la Côte-Ste-Catherine, Quebec, H3T 1A8, Canada
| | - Mélanie Perroux
- University of Montreal Public Health Research Institute (IRSPUM), C.P. 6128 succ. Centre-Ville, Montreal, Quebec, H3C 3J7, Canada
| | - Catherine Larouche
- University of Montreal, Faculty of Nursing, University of Montreal Public Health Research Institute (IRSPUM), Pavillon Marguerite-d'Youville, 2375, chemin de la Côte-Ste-Catherine, Quebec, H3T 1A8, Canada.
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Riisgaard H, Nexøe J. Successful task delegation in general practice - a way to maintain primary health care in the future. Scand J Prim Health Care 2017; 35:111-112. [PMID: 28613128 PMCID: PMC5499309 DOI: 10.1080/02813432.2017.1335056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Courtenay M, Rowbotham S, Lim R, Deslandes R, Hodson K, MacLure K, Peters S, Stewart D. Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management. BMJ Open 2017; 7:e013515. [PMID: 28298366 PMCID: PMC5353344 DOI: 10.1136/bmjopen-2016-013515] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/27/2016] [Accepted: 02/02/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations. DESIGN Mixed methods. SETTING Primary care. PARTICIPANTS Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs). RESULTS Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patient-centred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction. CONCLUSIONS NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Samantha Rowbotham
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia
| | | | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Karen Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Associations between degrees of task delegation and job satisfaction of general practitioners and their staff: a cross-sectional study. BMC Health Serv Res 2017; 17:44. [PMID: 28095846 PMCID: PMC5240386 DOI: 10.1186/s12913-017-1984-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the healthcare system in the western world has undergone a structural development caused by changes in demography and pattern of disease. In order to maintain the healthcare system cost-effective, new tasks are placed in general practice urging the general practitioners to rethink the working structure without compromising the quality of care. However, there is a substantial variation in the degree to which general practitioners delegate tasks to their staff, and it is not known how these various degrees of task delegation influence the job satisfaction of general practitioners and their staff. METHODS We performed a cross-sectional study based on two electronic questionnaires, one for general practitioners and one for their staff. Both questionnaires were divided into two parts, a part exploring the degree of task delegation regarding management of patients with chronic obstructive pulmonary disease in general practice and a part concerning the general job satisfaction and motivation to work. RESULTS We found a significant association between perceived "maximal degree" of task delegation in management of patients with chronic obstructive pulmonary disease and the staff's overall job satisfaction. The odds ratio of the staff's satisfaction with the working environment displayed a tendency that there is also an association with "maximal degree" of task delegation. In the analysis of the general practitioners, the odds ratios of the results indicate that there is a tendency that "maximal degree" of task delegation is associated with overall job satisfaction, satisfaction with the challenges in work, and satisfaction with the working environment. CONCLUSIONS We conclude that a high degree of task delegation is significantly associated with overall job satisfaction of the staff, and that there is a tendency that a high degree of task delegation is associated with the general practitioners' and the staff's satisfaction with the working environment as well as with general practitioners' overall job satisfaction and satisfaction with challenges in work. To qualify future delegation processes within general practice, further research could explore the reasons for our findings.
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Liu JM, Xu RX, Hu YS, Ren LK, Qiao H, Ding H, Liu ZL. Chinese Internet Searches Provide Inaccurate and Misleading Information to Epilepsy Patients. Chin Med J (Engl) 2016; 128:3324-8. [PMID: 26668147 PMCID: PMC4797508 DOI: 10.4103/0366-6999.171425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Most patients with epilepsy want to learn as much as possible about the disease, and many have turned to the internet for information. Patients are likely to use information obtained from the internet to control their epilepsy, but little is known about the accuracy of this information. In this survey, we have assessed the feasibility and usability of internet-based interventions for the treatment of epilepsy. Methods: Data were collected from an internet search. Different search terms were used to obtain general information on epilepsy together with information about medication, types of epilepsy, treatment, women's health, and other information. The accuracy of the information was evaluated by a group of experts. Results: A total of 1320 web pages were assessed. The majority were websites related to health. A large number (80.2%) of web pages contained content related to the search term. A significant number of web pages 450/1058 (42.5%) claimed to provide information from a credible source; however, only 206/1058 (19.5%) of the information was accurate and complete; 326/1058 (30.8%) was accurate but incomplete; 328/1058 (31.0%) was correct but nonstandard, and 198/1058 (18.8%) was inaccurate. The authenticity of the information was not significantly different between the two search engines (χ2 = 0.009, P = 0.924). No significant difference was observed in the information obtained from a specialist or nonspecialist source (χ2 = 7.538, P = 0.057). There was also no correlation between the quality of the information and the priority (χ2 = 6.880, P = 0.076). Conclusions: Searching for information about epilepsy on the internet is convenient, but the information provided is not reliable. Too much information is inaccurate or for advertisement purposes, and it is difficult for patients to find the useful information. Turning to the internet for medical knowledge may be harmful. Physicians should be aware that their patients may search for information on the internet and guide them to safe, reputable websites.
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Affiliation(s)
| | - Ru-Xiang Xu
- Affiliated Bayi Brain Hospital, Bayi Clinical College, Southern Medical University, Beijing 100700, China
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Hoare KJ, Decker E. The role of a sexual health promotion leaflet for 15-18 year olds in catalysing conversations: A constructivist grounded theory. Collegian 2016; 23:3-11. [PMID: 27188034 DOI: 10.1016/j.colegn.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Following the summer holidays of 2011, twelve girls returned to school pregnant in one high school in Auckland New Zealand (NZ). A health promotion leaflet that folded into.a small square containing a condom and was dubbed the 'teabag' was distributed to 15-18 year olds prior to the summer holiday of 2012, in order to increase their sexual health knowledge. This paper reports on the evaluation of the teabag from the students' perspective. During the first term of 2013, seventeen students from two high schools who had received the teabag were interviewed. Five were male and twelve female. Most (16) were of Pacific Island or Maori (indigenous New Zealanders) descent. Interviews were digitally recorded, transcribed, coded and categorised concurrently, in accordance with grounded theory methods. Theoretical sampling was employed and students who had perceptions of the teabag, that were consistent with evolving constructions from data, were invited by school nurses to be interviewed by the researchers. Interviews were coded line by line by two researchers and these codes collapsed into seven focussed codes. Further analysis resulted in the codes being subsumed into three main categories. These categories revealed that the teabag was, helpful, appropriate and became a talking point. The grounded theory and basic social process the researchers constructed from data were that the teabag catalysed conversations about sexual health. The teabag was an acceptable and appropriate sexual health promotion tool to disseminate information about sexual health.
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Contandriopoulos D, Brousselle A, Breton M, Sangster-Gormley E, Kilpatrick K, Dubois CA, Brault I, Perroux M. Nurse practitioners, canaries in the mine of primary care reform. Health Policy 2016; 120:682-9. [PMID: 27085958 DOI: 10.1016/j.healthpol.2016.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 01/13/2023]
Abstract
A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound environmental challenges are accumulating and are likely to drive significant transformation in the field. In this article we build upon the concept of "disruptive innovations" to analyze data from two separate research projects conducted in Quebec (Canada). Results from both projects suggest that introducing nurse practitioners into primary care teams has the potential to disrupt the status quo. We propose three scenarios for the future of primary care and for nurse practitioners' potential contribution to reforming primary care delivery models. In conclusion, we suggest that, like the canary in the coal mine, nurse practitioners' place in primary care will be an indicator of the extent to which healthcare system reforms have actually occurred.
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Affiliation(s)
- Damien Contandriopoulos
- Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada.
| | - Astrid Brousselle
- Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada.
| | - Mylaine Breton
- Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada.
| | | | - Kelley Kilpatrick
- Faculté des sciences infirmières, Université de Montréal, Canada; Maisonneuve-Rosemont Hospital Research Centre, Canada.
| | - Carl-Ardy Dubois
- Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada.
| | - Isabelle Brault
- Faculté des sciences infirmières, Université de Montréal, Canada.
| | - Mélanie Perroux
- Faculté des sciences infirmières, Université de Montréal, Canada.
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Contandriopoulos D, Duhoux A, Roy B, Amar M, Bonin JP, Borges Da Silva R, Brault I, Dallaire C, Dubois CA, Girard F, Jean E, Larue C, Lessard L, Mathieu L, Pépin J, Perroux M, Cockenpot A. Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper. BMJ Open 2015; 5:e010559. [PMID: 26700294 PMCID: PMC4691711 DOI: 10.1136/bmjopen-2015-010559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. METHODS AND ANALYSIS The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. ETHICS AND DISSEMINATION The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.
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Affiliation(s)
| | - Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Bernard Roy
- Faculty of Nursing, University of Laval, Québec, Québec, Canada
| | - Maxime Amar
- Faculty of Medicine, University of Laval, Québec, Québec, Canada
| | - Jean-Pierre Bonin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Francine Girard
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Caroline Larue
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Lily Lessard
- University of Québec in Rimouski, Rimouski, Québec, Canada
| | - Luc Mathieu
- University of Sherbrook, School of Nursing, Sherbrooke, Québec, Canada
| | - Jacinthe Pépin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Mélanie Perroux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Aurore Cockenpot
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
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Krucien N, Le Vaillant M, Pelletier‐Fleury N. What are the patients' preferences for the Chronic Care Model? An application to the obstructive sleep apnoea syndrome. Health Expect 2015; 18:2536-48. [PMID: 24948135 PMCID: PMC5810656 DOI: 10.1111/hex.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 11/28/2022] Open
Abstract
CONTEXT The Chronic Care Model (CCM) has been developed to improve the quality of medical care delivered by general practitioners to patients with multiple chronic conditions. Despite an increasing use of this model, it remains unclear to what extent the different recommendations are valued by the patients. OBJECTIVE This study aims to identify the preferences of patients with multiple chronic conditions for recommendations of the Chronic Care Model. METHODS The patients' preferences were identified with a discrete choice experiment. The hypothetical general practice cares were described using 10 recommendations of the Chronic Care Model (i.e. shared decision making; informational continuity (INF); regular follow-up; planned care; communication; collaboration with a nurse; advices on health habits; patient empowerment; psychological support; coordination). Respondents were consecutively recruited in a hospital setting during routine follow-up visits to their pulmonary specialist. The sample of respondents included 150 patients with multiple chronic conditions in addition to an obstructive sleep apnoea syndrome. RESULTS The INF is highly valued by the patients. At the opposite, patients do not appear to value collaboration between nurses and GPs. To a large extent, the patients' preferences for the recommendations of the CCM depend on their gender, number of chronic conditions and self-perceived health condition. DISCUSSION The INF appeared to be a minimal requirement to ensure high-quality general practice care. The significant interactions between the patients' socio-demographic characteristics and their preferences for the CCM highlighted the necessity to deliver personalized services.
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Affiliation(s)
- Nicolas Krucien
- Health Economics Research UnityUniversity of AberdeenAberdeenUK
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Influence of provider mix and regulation on primary care services supplied to US patients. HEALTH ECONOMICS POLICY AND LAW 2015; 11:193-213. [PMID: 26443665 DOI: 10.1017/s1744133115000390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Access to medical care and how it differs for various patients remain key policy issues. While existing work has examined clinic structure's influence on productivity, less research has explored the link between provider mix and access for different patient types - which also correspond to different service prices. We exploit experimental data from a large field study spanning 10 US states where trained audit callers were randomly assigned an insurance status and then contacted primary care physician practices seeking new patient appointments. We find clinics with more non-physician clinicians are associated with better access for Medicaid patients and lower prices for office visits; however, these relationships are only found in states granting full practice autonomy to these providers. Substituting more non-physician labor in primary care settings may facilitate greater appointment availability for Medicaid patients, but this likely rests on a favorable policy environment. Relaxing regulations for non-physicians may be an important initiative as US health reforms continue and also relevant to other countries coping with greater demands for medical care and related financial strain.
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Turnock A, Morgan S, Henderson K, Tapley A, van Driel M, Oldmeadow C, Ball J, Presser J, Davey A, Scott J, Magin P. Prevalence and associations of general practice nurses' involvement in consultations of general practitioner registrars: a cross-sectional analysis. AUST HEALTH REV 2015; 40:92-99. [PMID: 26117411 DOI: 10.1071/ah15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish prevalence and associations of general practice nurses' (GPNs) involvement in general practitioner (GP) registrars' consultations. METHODS A cross-sectional analysis from an ongoing cohort study of registrars' clinical consultations in five Australian states. Registrars recorded detailed data from 60 consecutive consultations per 6-month training term. Problems and diagnoses encountered, including chronic disease classification, were coded using the International Classification of Primary Care, second edition duplication system (ICPC-2plus) classification system. The outcome factor in our analysis was GPN involvement in management of individual problems and diagnoses. Independent variables were a range of patient, registrar, practice, consultation and educational factors. RESULTS We analysed 108 759 consultations of 856 registrars including 169 307 problems or diagnoses. Of the problems/diagnoses, 5.1% (95% confidence interval (CI) 5.0-5.2) involved a GPN. Follow-up with a GPN was organised for 1.5% (95% CI 1.4-1.5) of all problems/diagnoses. Significant associations of GPN involvement included patient age, male sex, Aboriginal or Torres Strait Islander status, non-English-speaking background (NESB) and the patient being new to the practice. Larger practice size, the particular training organisation, and the problem/diagnosis being new and not a chronic disease were other associations. CONCLUSIONS Associations with Aboriginal or Torres Strait Islander status and NESB status suggest GPNs are addressing healthcare needs of these under-serviced groups. But GPNs may be underutilised in chronic disease care.
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Affiliation(s)
- Allison Turnock
- Tropical Medical Training, 100 Angus Smith Drive, Townsville, Qld, 4814, Australia.
| | - Simon Morgan
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Kim Henderson
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Amanda Tapley
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, L8 Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane, Qld 4029, Australia. Email
| | - Chris Oldmeadow
- University of Newcastle, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Jean Ball
- Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. Email
| | - Jenny Presser
- Tropical Medical Training, 100 Angus Smith Drive, Townsville, Qld, 4814, Australia.
| | - Andrew Davey
- University of Newcastle, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - John Scott
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
| | - Parker Magin
- General Practice Training Valley to Coast, PO Box 573, Hunter Regional Mail Centre, NSW 2310, Australia. , ,
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Maul TM, Zaidi A, Kowalski V, Hickey J, Schnug R, Hindes M, Cook S. Patient Preference and Perception of Care Provided by Advance Nurse Practitioners and Physicians in Outpatient Adult Congenital Clinics. CONGENIT HEART DIS 2015; 10:E225-9. [PMID: 26010340 DOI: 10.1111/chd.12273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Nurse practitioners (NPs) have an established role for delivering competent care to patients in the primary care setting. The aim of this study was to compare satisfaction of patients managed by NPs vs. physicians in the outpatient adult congenital heart disease (CHD) clinic. DESIGN A prospective study conducted in two outpatient adult CHD clinics to assess patient satisfaction through standardized surveys. Demographic data included CHD diagnosis, age, and New York Heart Association functional class. All patients completed a Short-Form-12 to assess health status. RESULTS Of the 371 patients recruited (52% men; median age 29 years, severe CHD complexity 31.5%) and seen by NP (n = 187) or physician (n = 184), physician-managed practices had higher perceived: overall experience, courtesy of provider (P < 0.05) and confidence (trust) in provider (P < 0.1). Overall, patients reported satisfaction with an NP providing care (98%), the NP was able to effectively deal with illness/CHD (95%), and an increased chance (94%) or willingness to see an NP at a future visit. Only 73% reported an understanding of NP training and how an NP differed from a registered nurse. There was a stronger perception of how an NP differed from a physician (83%). CONCLUSION Patient satisfaction was high regardless of whether care was provided by physicians or NPs. However, patients appear to make distinctions in what they believe the type of care each practitioner is best at providing. Patient education regarding competence of the different health care providers may continue to improve patient satisfaction.
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Affiliation(s)
- Timothy M Maul
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ali Zaidi
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Vanessa Kowalski
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenne Hickey
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Renee Schnug
- Cardiology, The Columbus Ohio Adult Congenital Heart Program (COACH), Columbus, OH, USA
| | - Morgan Hindes
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Cook
- The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tsiachristas A, Wallenburg I, Bond CM, Elliot RF, Busse R, van Exel J, Rutten-van Mölken MP, de Bont A. Costs and effects of new professional roles: Evidence from a literature review. Health Policy 2015; 119:1176-87. [PMID: 25899880 DOI: 10.1016/j.healthpol.2015.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs. A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985-2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies. Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8). Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.
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Affiliation(s)
- A Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
| | - I Wallenburg
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - C M Bond
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - R F Elliot
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - R Busse
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - J van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - A de Bont
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Pirret AM, Neville SJ, La Grow SJ. Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: A comparative study. Int J Nurs Stud 2015; 52:716-26. [DOI: 10.1016/j.ijnurstu.2014.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
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Contandriopoulos D, Brousselle A, Dubois CA, Perroux M, Beaulieu MD, Brault I, Kilpatrick K, D'Amour D, Sansgter-Gormley E. A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis. BMC Health Serv Res 2015; 15:78. [PMID: 25889415 PMCID: PMC4349481 DOI: 10.1186/s12913-015-0731-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/06/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations. METHODS In the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec. RESULTS Five core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support. The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes. CONCLUSION It concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.
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Affiliation(s)
- Damien Contandriopoulos
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Astrid Brousselle
- Department of Community Health Sciences, University of Sherbrooke, 150, place Charles-Le Moyne, Bureau 200, Longueuil, Québec, J4K 0A8, Canada.
| | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Mélanie Perroux
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Marie-Dominique Beaulieu
- Department of Family Medicine and Emergency Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900, boul Édouard Montpetit, Montréal, Québec, H3T 1J4, Canada.
| | - Isabelle Brault
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Kelley Kilpatrick
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Danielle D'Amour
- Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
| | - Esther Sansgter-Gormley
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
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Chattopadhyay A, Zangaro GA, White KM. Practice Patterns and Characteristics of Nurse Practitioners in the United States: Results From the 2012 National Sample Survey of Nurse Practitioners. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.11.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Halcomb E, Davies D, Salamonson Y. Consumer satisfaction with practice nursing: a cross-sectional survey in New Zealand general practice. Aust J Prim Health 2015; 21:347-53. [DOI: 10.1071/py13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022]
Abstract
An important consideration in health service delivery is ensuring that services meet consumer needs. Whilst nursing services in primary care have grown internationally, there has been limited exploration of consumer satisfaction with these services. This paper reports a descriptive survey that sought to evaluate consumers’ perceptions of New Zealand practice nurses (PNs). One thousand, five hundred and five patients who received nursing services at one of 20 participating New Zealand general practices completed a survey tool between December 2010 and December 2011. The 64-item self-report survey tool contained the 21-item General Practice Nurse Satisfaction (GPNS) scale. Data were analysed using both descriptive and inferential statistics. Internal consistency of the GPNS scale was high (Cronbach’s α 0.97). Participants aged over 60 years and those of European descent were significantly less satisfied with the PN (P = 0.001). Controlling for these characteristics, participants who had visited the PN more than four times previously were 1.34 times (adjusted odds ratio 1.34 (95% CI: 1.06–1.70) more satisfied than the comparison group (up to 4 previous visits to PN). In addition to the further validation of the psychometric properties of the GPNS scale in a different setting, the study also revealed a high level of satisfaction with PNs, with increased satisfaction with an increased number of visits. Nevertheless, the lower levels of satisfaction with PNs in the older age group as well as those of European descent, warrants further examination. The study also highlights the need for PNs and consumers to discuss consumer’s expectations of services and create a shared understanding of treatment goals.
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Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf) 2014; 37:716-27. [PMID: 25525194 DOI: 10.1093/pubmed/fdu102] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The epidemiological transition calls for redefining the roles of the various professionals involved in primary health care towards greater collaboration. We aimed to identify facilitators of, and barriers to, interprofessional collaboration in primary health care as perceived by the actors involved, other than nurses. METHODS Systematic review using synthetic thematic analysis of qualitative research. Articles were retrieved from Medline, Web of science, Psychinfo and The Cochrane library up to July 2013. Quality and relevance of the studies were assessed according to the Dixon-Woods criteria. The following stakeholders were targeted: general practitioners, pharmacists, mental health workers, midwives, physiotherapists, social workers and receptionists. RESULTS Forty-four articles were included. The principal facilitator of interprofessional collaboration in primary care was the different actors' common interest in collaboration, perceiving opportunities to improve quality of care and to develop new professional fields. The main barriers were the challenges of definition and awareness of one another's roles and competences, shared information, confidentiality and responsibility, team building and interprofessional training, long-term funding and joint monitoring. CONCLUSIONS Interprofessional organization and training based on appropriate models should support collaboration development. The active participation of the patient is required to go beyond professional boundaries and hierarchies. Multidisciplinary research projects are recommended.
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Affiliation(s)
- I Supper
- Department of General Practice, University of Lyon 1, Lyon, France
| | - O Catala
- Department of Pharmacy, University of Lyon 1, Lyon, France
| | - M Lustman
- Department of Sociology, University of Lilles, Lilles, France
| | - C Chemla
- Department of Psychology, University of Lyon 2, Lyon, France
| | - Y Bourgueil
- Institute for Research and Information in Health Economics, IRDES, Paris, France
| | - L Letrilliart
- Department of General Practice, University of Lyon 1, Lyon, France
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Gibb MA, Edwards HE, Gardner GE. Scoping study into wound management nurse practitioner models of practice. AUST HEALTH REV 2014; 39:220-227. [PMID: 25493448 DOI: 10.1071/ah14040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The primary objective of this research was to investigate wound management nurse practitioner (WMNP) models of service for the purposes of identifying parameters of practice and how patient outcomes are measured. METHODS A scoping study was conducted with all authorised WMNPs in Australia from October to December 2012 using survey methodology. A questionnaire was developed to obtain data on the role and practice parameters of authorised WMNPs in Australia. The tool comprised seven sections and included a total of 59 questions. The questionnaire was distributed to all members of the WMNP Online Peer Review Group, to which it was anticipated the majority of WMNPs belonged. RESULTS Twenty-one WMNPs responded (response rate 87%), with the results based on a subset of respondents who stated that, at the time of the questionnaire, they were employed as a WMNP, therefore yielding a response rate of 71% (n=15). Most respondents (93%; n=14) were employed in the public sector, with an average of 64 occasions of service per month. The typical length of a new case consultation was 60 min, with 32 min for follow ups. The most frequently performed activity was wound photography (83%; n=12), patient, family or carer education (75%; n=12), Doppler ankle-brachial pressure index assessment (58%; n=12), conservative sharp wound debridement (58%; n=12) and counselling (50%; n=12). The most routinely prescribed medications were local anaesthetics (25%; n=12) and oral antibiotics (25%; n=12). Data were routinely collected by 91% of respondents on service-related and wound-related parameters to monitor patient outcomes, to justify and improve health services provided. CONCLUSION This study yielded important baseline information on this professional group, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are measured.
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Affiliation(s)
- Michelle A Gibb
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia
| | - Helen E Edwards
- Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia. Email
| | - Glenn E Gardner
- Queensland University of Technology and Royal Brisbane and Women's Hospital, Level 3N Block, Kelvin Grove, Qld 4059, Australia. Email
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Measurement properties of the Brazilian Portuguese version of the MedRisk instrument for measuring patient satisfaction with physical therapy care. J Orthop Sports Phys Ther 2014; 44:879-89. [PMID: 25361861 DOI: 10.2519/jospt.2014.5150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Clinical measurement study. OBJECTIVES To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties. BACKGROUND To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil. METHODS The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects. RESULTS Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience and efficiency, and patient education provided the best factor loadings. Cronbach alpha coefficients ranged from .63 to .77, intraclass correlation coefficients ranged from 0.64 to 0.79, and standard errors of measurement ranged from 0.86 to 1.75 points. Thirteen items of the MRPS were moderately correlated with the global measure of change. A large ceiling effect was detected. CONCLUSION Although we did not fully achieve the measurement properties suggested by the guidelines, we believe that the MRPS can be used among Brazilian Portuguese-speaking patients. Some differences with regard to factor structure of the Brazilian Portuguese MPRS compared with the English version were observed. The reason for this is likely a combination of cultural aspects, differences in clinical settings, and patient expectation.
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Parker R, Forrest L, McCracken J, McRae I, Cox D. What primary health-care services are Australian consumers willing to accept from nurse practitioners? A National Survey. Health Expect 2014; 17:733-40. [PMID: 22784392 PMCID: PMC5060916 DOI: 10.1111/j.1369-7625.2012.00800.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nurses are becoming increasingly important as providers of primary health care in Australia. In November 2010, Medicare provider rights and Pharmaceutical Benefits Scheme rights for nurse practitioners, working in private practice and in collaboration with a medical practitioner, were introduced in Australia. Although international evidence suggests that nurse practitioners would be appropriate and acceptable providers of care at the first point of contact, such as primary health care, there is little Australian evidence about what care consumers are willing to accept from nurse practitioners. OBJECTIVES To ascertain what care Australian health-care consumers would accept from nurse practitioners in this setting. PARTICIPANTS Australian adults over 18 years of age. METHODS National Survey delivered online. Information about the survey was disseminated through a media campaign, stakeholder engagement and through the health-care consumer networks nationally. RESULTS The total number of respondents that started the survey was n = 1883. Ninety-five percentage (n = 1784) of respondents completed the survey. The majority of respondents were women, aged 25-54 years, had completed tertiary education and had an annual household income of more than A$80,000. The majority of the respondents (n = 1562, 87%) said they would be prepared to see a nurse practitioner for some of their primary health-care needs. CONCLUSIONS The findings of this study suggest consumers are accepting of a range of activities undertaken by nurse practitioners in primary health care and this has relevance for primary health-care workforce mix and organization, particularly for areas that are underserved by medical practitioners.
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Affiliation(s)
- Rhian Parker
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Laura Forrest
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - James McCracken
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Ian McRae
- Australian Primary Care Research InstituteAustralian National UniversityActonACTAustralia
| | - Darlene Cox
- Health Care Consumers' Association of the Australian Capital TerritoryCanberraACTAustralia
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Tinelli M, Nikoloski Z, Kumpunen S, Knai C, Pribakovic Brinovec R, Warren E, Wittgens K, Dickmann P. Decision-making criteria among European patients: exploring patient preferences for primary care services. Eur J Public Health 2014; 25:3-9. [DOI: 10.1093/eurpub/cku082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Martínez-González NA, Djalali S, Tandjung R, Huber-Geismann F, Markun S, Wensing M, Rosemann T. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC Health Serv Res 2014; 14:214. [PMID: 24884763 PMCID: PMC4065389 DOI: 10.1186/1472-6963-14-214] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 03/10/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. METHODS We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. RESULTS 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N ≤ 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. CONCLUSIONS The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.
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Affiliation(s)
| | - Sima Djalali
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Ryan Tandjung
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Flore Huber-Geismann
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Michel Wensing
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
- Scientific Institute for Quality in Healthcare, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, Netherlands
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
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Janssen BM, Van Regenmortel T, Abma TA. Balancing risk prevention and health promotion: towards a harmonizing approach in care for older people in the community. HEALTH CARE ANALYSIS 2014; 22:82-102. [PMID: 22228192 PMCID: PMC3921446 DOI: 10.1007/s10728-011-0200-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky's salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others' perspective, and have a dialogue with each other, taking the life narrative of clients into account.
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Affiliation(s)
- Bienke M. Janssen
- Department of Social Studies, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, The Netherlands
| | - Tine Van Regenmortel
- Department of Social Studies, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, The Netherlands
- Faculty of Social Sciences and Research Institute for Labour and Society (HIVA), Catholic University Leuven, Parkstraat 47, 5300, 3000 Leuven, Belgium
| | - Tineke A. Abma
- Department of Medical Humanities, EMGO Institute, VU Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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