scholarly journals Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey

2019 ◽  
Vol 43 (1) ◽  
pp. 55 ◽  
Author(s):  
Jane Currie ◽  
Mary Chiarella ◽  
Thomas Buckley
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Health Care Services ◽  
Care Delivery ◽  
Free Text ◽  
Fee For Service ◽  
Text Data ◽  
Legislative Changes ◽  
Provision Of Care ◽  
Pharmaceutical Benefits Scheme

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included ‘duplication of services’ and ‘level of reimbursement’. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs’ provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

scholarly journals Virtual visits: Friend or foe of patient-centred care?

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Kim Mcgrail
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Service Use ◽  
Care Delivery ◽  
Demographic Data ◽  
Prescription Data ◽  
Fee For Service ◽  
System Perspective ◽  
Virtual Visits ◽  
New Form

ABSTRACT BackgroundPatient-initiated virtual visit consultations in primary care are a new form of care that is increasingly available in parts of Canada. There is a need to develop an understanding of patient perspectives on virtual visits and how they affect patient experience, access to care, and health services utilization patterns from a system perspective. This paper will shed some light on this new form of patient care delivery. ApproachWe accessed fee-for-service physician payment data, patient and physician demographic data, and PharmaNet prescription data, from 2010/11–2013/14. We examined overall utilization of GP virtual visits defined by BC physician billing codes to understand the characteristics of providers and patients providing and using these services. We assessed the relationship of virtual visits with other types of care including referrals to specialist services, medication prescribing, and overall costs of physician care. We used a matched cohort and time series analysis to answer the question of whether virtual visits displace or add to other forms of patient care. ResultsWhile the growth in virtual visits has been rapid in BC, these services still represent a very small proportion of overall primary care. There are patient users in urban and rural regions of BC, but less than 1% of the BC population has had a virtual visit. Users of virtual visits tend to be younger and use is more likely for people with one or more major conditions (measured by ADGs). Only 144 primary care GPs (out of close to 5,000 in BC) provided virtual visits in 2013/14. About one-third of patients have a virtual visit with a physician already known to them, with the rest seeing a physician for the first time during their virtual visit. These visits do not appear to add costs to care, though there is a suggestion that it they are more effective as part of an ongoing therapeutic relationship. ConclusionVirtual visits are a small portion of total primary care but are expected to increase. In some cases virtual visits appear to supplement existing forms of access, offering a new means by which to interact with a known provider. In other cases virtual care is with a new provider, which may suggest walk-in clinic type of service use. The implications of these two scenarios are clearly different, and further research with longer follow-up will be helpful in understanding long-term implications.

scholarly journals People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study

10.2196/24531 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e24531 ◽  
Author(s):  
Jennifer MJ Isautier ◽  
Tessa Copp ◽  
Julie Ayre ◽  
Erin Cvejic ◽  
Gideon Meyerowitz-Katz ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Patient Activation ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Appointment ◽  
Free Text Response

Background In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. Objective This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. Methods A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. Results Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. Conclusions Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.

scholarly journals Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey

2017 ◽  
Vol 41 (5) ◽  
pp. 533 ◽  
Author(s):  
Jane Currie ◽  
Mary Chiarella ◽  
Thomas Buckley
Keyword(s):  
Access To Care ◽  
Nurse Practitioners ◽  
National Survey ◽  
Medical Practitioner ◽  
Patient Access ◽  
Medical Practitioners ◽  
Electronic Survey ◽  
Legislative Changes ◽  
The Impact ◽  
Pharmaceutical Benefits Scheme

Objective Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia. Methods PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed. Results Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS. Conclusion Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal. What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known. What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia. What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.

scholarly journals People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study (Preprint)

2020 ◽  
Author(s):  
Jennifer MJ Isautier ◽  
Tessa Copp ◽  
Julie Ayre ◽  
Erin Cvejic ◽  
Gideon Meyerowitz-Katz ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Patient Activation ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Appointment ◽  
Free Text Response

BACKGROUND In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. OBJECTIVE This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. METHODS A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. RESULTS Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (<i>P</i>=.007), having a history of both depression and anxiety (<i>P</i>=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (<i>P</i>=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. CONCLUSIONS Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.

A Numerically Coded File of Operative Procedures Derived from a Free Text Data Collection System : A Measure of the Accuracy

1976 ◽  
Vol 15 (01) ◽  
pp. 21-28 ◽  
Author(s):  
Carmen A. Scudiero ◽  
Ruth L. Wong
Keyword(s):  
Data Collection ◽  
Pap Smear ◽  
Operative Procedures ◽  
Free Text ◽  
Collection System ◽  
Process Data ◽  
Text Data ◽  
Data Collection System ◽  
History Of ◽  
Correlation System

A free text data collection system has been developed at the University of Illinois utilizing single word, syntax free dictionary lookup to process data for retrieval. The source document for the system is the Surgical Pathology Request and Report form. To date 12,653 documents have been entered into the system.The free text data was used to create an IRS (Information Retrieval System) database. A program to interrogate this database has been developed to numerically coded operative procedures. A total of 16,519 procedures records were generated. One and nine tenths percent of the procedures could not be fitted into any procedures category; 6.1% could not be specifically coded, while 92% were coded into specific categories. A system of PL/1 programs has been developed to facilitate manual editing of these records, which can be performed in a reasonable length of time (1 week). This manual check reveals that these 92% were coded with precision = 0.931 and recall = 0.924. Correction of the readily correctable errors could improve these figures to precision = 0.977 and recall = 0.987. Syntax errors were relatively unimportant in the overall coding process, but did introduce significant error in some categories, such as when right-left-bilateral distinction was attempted.The coded file that has been constructed will be used as an input file to a gynecological disease/PAP smear correlation system. The outputs of this system will include retrospective information on the natural history of selected diseases and a patient log providing information to the clinician on patient follow-up.Thus a free text data collection system can be utilized to produce numerically coded files of reasonable accuracy. Further, these files can be used as a source of useful information both for the clinician and for the medical researcher.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

2021 ◽  
pp. 019394592110089
Author(s):  
Jee Young Joo ◽  
Megan F. Liu
Keyword(s):  
Health Care ◽  
Case Management ◽  
Scoping Review ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Management Practice ◽  
Empirical Studies ◽  
Chronic Illnesses ◽  
Future Research

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients’ satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

scholarly journals Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 528
Author(s):  
Cristian Lieneck ◽  
Brooke Herzog ◽  
Raven Krips
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Routine Care ◽  
Future Research ◽  
Healthcare Organizations ◽  
Care Services ◽  
Global Pandemic ◽  
Facilitators And Barriers

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

scholarly journals Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Multidisciplinary Care ◽  
The United States ◽  
Comprehensive Care ◽  
Patient Support ◽  
Patient Support Group ◽  
Patient Advocates

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

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