scholarly journals Integrating nurse practitioners into primary care: policy considerations from a Canadian province

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stacey Black ◽  
Raad Fadaak ◽  
Myles Leslie
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care System ◽  
Structured Interviews ◽  
Primary Care Delivery ◽  
Key Stakeholders ◽  
The Status ◽  
Practice Opportunities ◽  
Care System

Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

scholarly journals Easier Said Than Done: Healthcare Professionals’ Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity

2021 ◽  
Vol 18 (11) ◽  
pp. 6057
Author(s):  
Sanne J. Kuipers ◽  
Anna P. Nieboer ◽  
Jane M. Cramm
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Time Pressure ◽  
Care Delivery ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Primary Care Delivery

Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.

scholarly journals Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

2021 ◽  
pp. BJGP.2020.1112
Author(s):  
Marta Wanat ◽  
Melanie Hoste ◽  
Nina Gobat ◽  
Marilena Anastasaki ◽  
Femke Boehmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Practical Training ◽  
Structured Interviews ◽  
New Ways Of Working ◽  
Primary Care Delivery ◽  
Local Primary Care ◽  
Remote Care

Background: Primary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim: To understand the experiences of European PCPs working during the first peak of the COVID-19 pandemic. Design and Setting: An exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were audio recorded, transcribed and analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and deal with uncertainty. Conclusion: PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions will facilitate easy and coordinated access to practical information on how to adapt services, ongoing training and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

Primary Care and Physician Shortages

2014 ◽  
pp. 10-30
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Community Health Centers ◽  
Physician Assistants ◽  
Healthcare Services ◽  
Primary Care System ◽  
After Hours Care ◽  
Care Models ◽  
Provider Shortages ◽  
Care System

In this chapter, the author provides an overview of the primary care system. Primary care is the backbone of healthcare systems and is defined as “the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community” (Donaldson, 1996, p. 1). The primary care system in the United States is stricken with chronic systematic problems related to access, cost, and provider shortages. The chapter explicates the impact of recent legislation, including the Patient Protection and Affordable Care Act (PPACA) on these issues. It also highlights some solutions to increase access such as Community Health Centers (CHCs), the restructuring of care models to foster teamwork, the use of information technology, the provision of after-hours care, as well as the use of non-physician providers such as nurse practitioners and physician assistants.

scholarly journals Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care

2020 ◽  
Vol 55 (2) ◽  
pp. 178-189 ◽  
Author(s):  
Chuan‐Fen Liu ◽  
Paul L. Hebert ◽  
Jamie H. Douglas ◽  
Emily L. Neely ◽  
Christine A. Sulc ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care Delivery ◽  
Utilization Cost

scholarly journals Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

BJGP Open ◽  
2022 ◽  
pp. BJGPO.2021.0172
Author(s):  
Marta Wanat ◽  
Melanie Eugenie Hoste ◽  
Nina Helene Gobat ◽  
Marilena Anastasaki ◽  
Femke Böhmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Respiratory Infections ◽  
Care Delivery ◽  
European Countries ◽  
Structured Interviews ◽  
Delivery Of Care ◽  
Primary Care Delivery ◽  
The Impact ◽  
Remote Consultations

BackgroundThe impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care and understanding its benefits and drawbacks may inform its implementation during this and future healthcare emergencies.AimTo explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic.Design & settingQualitative study using semi-structured interviews in primary care in eight European countriesResultsWe conducted 146 interviews with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden and Germany). Data was collected between April and July 2020 and analysed using thematic analysis. We found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns.ConclusionRemote consultations for RTI symptoms may be acceptable long-term if both groups are happy to use this format but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.

scholarly journals Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

2021 ◽  
Vol 29 ◽  
Author(s):  
Tatiele Estefâni Schönholzer ◽  
Ione Carvalho Pinto ◽  
Fabiana Costa Machado Zacharias ◽  
Rodrigo André Cuevas Gaete ◽  
Maria Del Pilar Serrano-Gallardo
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Daily Life ◽  
Primary Care System ◽  
Structured Interviews ◽  
Learning Mechanisms ◽  
Primary Health ◽  
Care System

Objective: to understand how the implementation of the e-SUS Primary Care system has been processed and its impact on the daily life of the health teams. Method: a qualitative research study, conducted in a municipality in the inland of the state of São Paulo with professionals who work in Primary Health Care and use the e-SUS Primary Care system as a work tool. Semi-structured interviews and thematic data analysis were used with Kotter’s three-phase approach. Results: a total of 17 professionals, nurses, physicians, dentists and community agents were interviewed. The implementation of e-SUS Primary Care and its impact on the daily life of health teams were understood in terms of mandatory implementation; weaknesses for implementation, such as absence of material resources and implicit imposition for the use of the system; fragile training for deployment and learning from experience. Conclusion: a harmful incentive process was observed, conducted from the perspective of institutional pressure, use of the system to justify the work performed and, on the other hand, there was the creation of collaborative learning mechanisms between the teams.

scholarly journals Implementation of a transformative learning collaborative training for family doctor teams and managers: a description of participant process and perception

2020 ◽  
Author(s):  
Peiya Cao ◽  
Yanli Huang ◽  
Huiqiang Luo ◽  
Danping Liu
Keyword(s):  
Primary Care ◽  
Transformative Learning ◽  
Care Delivery ◽  
Family Doctor ◽  
Scale Up ◽  
Rapid Change ◽  
Primary Care System ◽  
Learning Collaborative ◽  
Family Doctors ◽  
Care System

Abstract Background: The Health Commission of Wuhou reformed its primary care system by implementing a Transformative Learning Collaborative (TLC): a structure that supports shared learning and rapid change among a group of providers or organisations. This paper examines the adaptation of a district TLC to implement, disseminate, and scale up the principles of a District Model for family doctor teams and managers of Community Health Centres (CHCs) in China. We describe TLC as a means of informing training content and evaluated the implementation through participant feedback. Methods: A district TLC was implemented to disseminate a District Model, which included six quality improvement principles and was developed to reform the primary care delivery process. Family doctor teams (n=26, 52 family doctor individuals) and managers (n=13) from thirteen CHCs in a Chinese district participated in the TLC organisation. The TLC process was described, and survey data served to assess the activities and resource usefulness. The perceived implementation enablers and inhibitors were also descriptively analysed. Results: The purpose, content, and process of TLC were described. The implementation included four steps: structure establishment, participants identification, activities implementation, and setting up a feedback system. The survey findings captured family doctors’ and managers’ feedback with regard to preference, needs, concerns, and problems in implementing TLC training. In general, most family doctors and managers indicated that TLC was necessary. All the successfully implemented Plan-Do-Study-Action cycles (77.6%) were applied to the model. Family doctors and managers agreed that coaches, a programme director, and data analysts were useful resources. The top three enablers for successful TLC implementation were managers’ support (93.9%); improvements in self-ability and team-based ability and impacts on participants’ career goals (89.8%), and support from family doctor teams (87.8%). Conclusions: This study offered a guided process for running TLC in the primary care system of China and provided valuable feedback from family doctors and managers regarding TLC training. Challenges were also found for future research and consideration. Our findings suggest that manager support is necessary for collaboration in family doctor teams and that participants play an important role by evaluating learning sessions and providing recommendations for future learning.

A Team-based Model of Primary Care Delivery and Physician-patient Interaction

2015 ◽  
Vol 128 (9) ◽  
pp. 1025-1028 ◽  
Author(s):  
Anita D. Misra-Hebert ◽  
Andrew Rabovsky ◽  
Chen Yan ◽  
Bo Hu ◽  
Michael B. Rothberg
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Patient Interaction ◽  
Primary Care Delivery ◽  
Physician Patient

scholarly journals Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review

2019 ◽  
Vol 6 ◽  
pp. 233339281984248
Author(s):  
Grant R. Martsolf ◽  
Ryan Kandrack ◽  
Mark W. Friedberg ◽  
Brian Briscombe ◽  
Peter S. Hussey ◽  
...  
Keyword(s):  
Primary Care ◽  
Narrative Review ◽  
Fee For Service ◽  
Primary Care System ◽  
High Functioning ◽  
Illness Burden ◽  
Care Practices ◽  
Primary Care Practices ◽  
Limited Generalizability ◽  
Care System

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices’ adoption of “comprehensive primary care” capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.

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