General practice nurses and physicians and end of life: a systematic review of models of care

2020 ◽  
pp. bmjspcare-2019-002114 ◽  
Author(s):  
Geoffrey Mitchell ◽  
Michèle Aubin ◽  
Hugh Senior ◽  
Claire Johnson ◽  
Julia Fallon-Ferguson ◽  
...  
Keyword(s):  
General Practice ◽  
Health System ◽  
End Of Life ◽  
Models Of Care ◽  
Case Conference ◽  
Practice Nurses ◽  
Patients With Cancer ◽  
Primary Care Practitioners ◽  
The Impact

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. In order to maximise the impact of GPs and GPNs, the impact of different models of care that have been developed to support their practice of EoLC needs to be understood.ObjectiveTo examine published models of EoLC that incorporate or support GP and GPN practice, and their impact on patients, families and the health system.MethodSystematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 13 papers reported models of care supporting the GP and GPN’s role in EoLC or PC practice. Services and guidelines for clinical issues have mixed impact on improving symptoms, but improved adherence to clinical guidelines. National Frameworks facilitated patients being able to die in their preferred place. A single specialist PC-GP case conference reduced hospitalisations, better maintained functional capacity and improved quality of life parameters in both patients with cancer and without cancer. No studies examined models of care aimed at supporting GPNs.ConclusionsPrimary care practitioners have a natural role to play in EoLC, and most patient and health system outcomes are substantially improved with their involvement. Successful integrative models need to be tested, particularly in non-malignant diseases. Such models need to be explored further. More work is required on the role of GPNs and how to support them in this role.

Systematic review of general practice end-of-life symptom control

2018 ◽  
Vol 8 (4) ◽  
pp. 411-420 ◽  
Author(s):  
Geoffrey K Mitchell ◽  
Hugh E Senior ◽  
Claire E Johnson ◽  
Julia Fallon-Ferguson ◽  
Briony Williams ◽  
...  
Keyword(s):  
General Practice ◽  
End Of Life ◽  
Regular Education ◽  
Early Stage ◽  
Symptom Control ◽  
Journal Articles ◽  
Practice Nurses ◽  
And Performance ◽  
And Training

BackgroundEnd of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.ObjectiveTo provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.MethodSystematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.ConclusionsIt is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and type of engagement in practice transformation. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care; and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported their perceptions of early outcomes of the PCMH model of care, describing enhanced patient and staff satisfaction and also noting fewer hospital admissions, as likely to reduce costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH models of care. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and approaches to PCMH transitions. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported early outcomes of the PCMH model of care, in particular enhanced patient and staff satisfaction and fewer hospital admissions which were described as likely to reduce the costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH Primary Health Care approaches. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

scholarly journals Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Zarni Htun ◽  
Yingxi Zhao ◽  
Hannah Gilbert ◽  
Chunling Lu
Keyword(s):  
Civil Society ◽  
Qualitative Study ◽  
Health System ◽  
Global Fund ◽  
Scale Up ◽  
Building Blocks ◽  
Key Informants ◽  
The Impact ◽  
Hiv Aids

Abstract Background The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). Methods We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. Results We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. Conclusion There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

2013 ◽  
Vol 19 (2) ◽  
pp. 150 ◽  
Author(s):  
Diann S. Eley ◽  
Elizabeth Patterson ◽  
Jacqui Young ◽  
Paul P. Fahey ◽  
Chris B. Del Mar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Models Of Care ◽  
Practice Nurses ◽  
Australian General Practice ◽  
General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

What practice nurses need to know about the NICE chronic kidney disease guidelines

2021 ◽  
Vol 32 (12) ◽  
pp. 468-472
Author(s):  
Peter Ellis
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Kidney Function ◽  
Practice Nurse ◽  
Nice Guidelines ◽  
Practice Nurses ◽  
Health Related ◽  
The Uk

Chronic kidney disease is highly prevalent in the community. Peter Ellis looks at the role of the practice nurse in diagnosing and managing chronic kidney disease in general practice Chronic kidney disease (CKD) is defined as a reduction in kidney function, or damage to kidney structure, which has persisted for greater than 3 months and which is associated with other health-related issues. While there are many causes of CKD, the most prevalent in western societies, including the UK, are diabetes and hypertension. This article identifies the role of the practice nurse in applying the National Institute for Health and Care Excellence (NICE) guidelines for CKD.

Health and wellbeing in general practice

2019 ◽  
Vol 29 (10) ◽  
pp. 40-42
Author(s):  
Jonathan McCutcheon
Keyword(s):  
General Practice ◽  
Practice Manager ◽  
Health And Wellbeing ◽  
The Impact

In this article, Jonathan McCutcheon looks at the impact of health and wellbeing on the role of a practice manager and what support can be accessed

scholarly journals Financial viability, benefits and challenges of employing a nurse practitioner in general practice

2015 ◽  
Vol 39 (2) ◽  
pp. 205 ◽  
Author(s):  
Christopher Helms ◽  
Jo Crookes ◽  
David Bailey
Keyword(s):  
General Practice ◽  
Nurse Practitioner ◽  
Primary Healthcare ◽  
Case Reports ◽  
Models Of Care ◽  
Careful Consideration ◽  
Scope Of Practice ◽  
Financial Viability ◽  
Practice Nurses

This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment. What is known about the topic? NPs represent a growing workforce of highly trained and educated advanced practice nurses that aims to improve access to timely and affordable healthcare for underserviced populations. Recent legislation has allowed for greater exploration of innovative models of care using NPs in Australian primary healthcare. What does this paper add? This case study provides practical information on the financial and logistical implications of employing an NP in a bulk-billing general practice. It demonstrates the broad capability of this workforce in Australian primary healthcare, and gives an overview of the facilitators and barriers to their use in private practice. What are the implications for practitioners? Employment of a PHC NP in general practice requires careful consideration of the direct and indirect benefits associated with the complimentary care they offer. NP access to the Medicare Benefits Schedule is severely restricted, which impairs their ability to achieve a full scope of practice and may contribute to increased health system costs and inefficiencies. There are opportunities for integration and facilitation of this emerging role in general practice with existing nursing workforce. Further research into this evolving area would be of benefit.

Next steps for student supervision and assessment

2019 ◽  
Vol 30 (10) ◽  
pp. 496-500
Author(s):  
Shaun Heath
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Communities Of Practice ◽  
Student Nurses ◽  
Education Standards ◽  
Student Placement ◽  
Practice Nurses ◽  
Primary Care Settings ◽  
Student Supervision

Student nurses are the future of the profession. Shaun Heath explains how changes to the Nursing and Midwifery Council's education standards will effect those currently acting as mentors and how all practice nurses can get involved and contribute to student placement experiences This article explores the Nursing and Midwifery Council's 2018 education standards and how these will affect the role of general practice nurses in primary care settings. The differing roles found in the standards will be discussed, alongside how primary care and the emerging Primary Care Networks can support learners in general practice through communities of practice.

Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit

2013 ◽  
Vol 37 (5) ◽  
pp. 632 ◽  
Author(s):  
Keith Cox ◽  
Deme Karikios ◽  
Jessica K. Roydhouse ◽  
Kate White
Keyword(s):  
Nurse Practitioner ◽  
Models Of Care ◽  
Presenting Problems ◽  
Medical Problems ◽  
Oncology Nurse ◽  
Recorded Data ◽  
The Impact ◽  
Clinical Workload

Objectives This case study evaluates the oncology nurse practitioner (NP) role in a chemotherapy unit. Background The NP works in the cancer centre of a major metropolitan public hospital. The NP role was established in the chemotherapy unit in 2007. The NP reviews all patients that have an unscheduled presentation to the unit, with symptoms relating either to their disease or treatment. Methods All unscheduled occasions of service provided by the NP in the chemotherapy unit over 6 months were recorded. Data were collected on patient demographic characteristics, medical problems and reason for presentation. Data on duration of care, interventions and outcomes administered by the NP were captured. Results There were 87 occasions of service (72 patients) during the study period. Nausea, vomiting or dehydration were the most common presenting problems and most presenting problems were moderate or severe (n = 73, 84%). The median time to review for the NP was 5 min and nearly all consultations (n = 83, 96%) took 30 min or less. Following NP consultation, most occasions of service did not require subsequent hospital admission (n = 52, 60%), medical advice (n = 61, 70%) or medical review (n = 75, 86%). Conclusions The NP is a valuable asset to a busy department, increasing access to timely and appropriate healthcare for patients on chemotherapy. What is known about the topic? Models of care for oncology NP roles are being developed in Australia, but few published reports and descriptions of the work of oncology NP exist. What does this paper add? This paper presents a description and evaluation of occasions of service for an oncology NP in a chemotherapy unit and the impact of the NP’s role on the hospital and clinical workload. What are the implications for practitioners? This paper can inform the development of other oncology NP roles in Australian chemotherapy units, and highlights potential areas of evaluation for new NP roles in cancer care.

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