The Influence of Individuals' Vulnerabilities and Their Interactions on the Assessment of a Primary Care Experience

Pre-post analysis of the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience

OBJECTIVE

This study aims to evaluate the impact of a primary care nurse practitioner (NP)-led clinic model piloted in British Columbia (Canada) on patients' health and care experience.

DESIGN

The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-led clinics. The prerostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic.

SETTING

To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from urban to suburban.

PARTICIPANTS

Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected.

PRIMARY OUTCOME MEASURES

The survey instrument was focused on five core dimensions of patients' primary care experience (accessibility, continuity, comprehensiveness, responsiveness and outcomes of care) as well as on the SF-12 Short-form Health Survey.

RESULTS

Scores for all dimensions of patients' primary care experience increased significantly: accessibility (T0=5.9, T1=7.9, p<0.001), continuity (T0=5.5, T1=8.8, p<0.001), comprehensiveness (T0=5.6, T1=8.4, p<0.001), responsiveness (T0=7.2, T1=9.5, p<0.001), outcomes of care (T0=5.0, T1=8.3, p<0.001). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.001) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709).

CONCLUSIONS

Our results suggest that the NP-led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Background:

Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care.

Methods:

We used a quasi-experimental longitudinal design based on a pre-and-post administered survey at a 2-year interval without a control group. We measured patient-reported accessibility, continuity, comprehensiveness, responsiveness and outcomes of care.

Results:

Results showed that patients who were newly registered with an IPCT had a significant increase in reported care experience, whereas patients who have been registered with an IPCT for 2 years prior to the first round of data collection had already high reported care experience that was maintained over time. Moreover, linear regression models showed statistically significant different increases in the dimensions of care experience by site and patients’ characteristics.

Conclusions:

Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved Patient Reported Experience Measures. These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.

Vulnerability and Primary Health Care: An Integrative Literature Review

The objective was to analyze the evidence available in the scientific literature on the concept of vulnerability, in theoretical perspectives and its use, in Primary Health Care. An integrative literature review was carried out with the inclusion criteria: articles in English, full text, peerreviewed, related to vulnerability and primary health care, with the explicit concept of vulnerability, and published until July 31, 2020. The electronic databases accessed were by crossing the descriptors "vulnerability," "vulnerabilities," "primary health care," "primary healthcare," and "primary care." The final sample consisted of 19 articles. The thematic analysis produced 2 themes: "Theoretical foundations of the concept of vulnerability" and "The use of the concept of vulnerability in PHC." In the second theme, 2 sub-themes emerged: Evaluation of health policies, programs, and services and Classification of individuals, groups, and families. There was a plurality of theoretical foundations for the concept of vulnerability and a smaller scope of its use in Primary Health Care. It is expected that the study will subsidize public policymakers and health teams in the design of services and actions aimed at vulnerable populations and in situations of vulnerability.