Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

Abstract Background Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. Methods A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. Results Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. Conclusions This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

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The communicative power of nurse practitioners in multidisciplinary primary healthcare teams

Journal of the American Academy of Nurse Practitioners ◽

10.1111/j.1745-7599.2012.00768.x ◽

2013 ◽

Vol 25 (2) ◽

pp. 91-102 ◽

Cited By ~ 18

Author(s):

Elizabeth Quinlan ◽

Susan Robertson

Keyword(s):

Nurse Practitioners ◽

Primary Healthcare ◽

Healthcare Teams ◽

Communicative Power

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A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis

BMC Health Services Research ◽

10.1186/s12913-015-0731-5 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 34

Author(s):

Damien Contandriopoulos ◽

Astrid Brousselle ◽

Carl-Ardy Dubois ◽

Mélanie Perroux ◽

Marie-Dominique Beaulieu ◽

...

Keyword(s):

Nurse Practitioners ◽

Primary Healthcare ◽

Healthcare Teams

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Identifying indicators sensitive to primary healthcare nurse practitioner practice: a review of systematic reviews protocol

BMJ Open ◽

10.1136/bmjopen-2020-043213 ◽

2021 ◽

Vol 11 (1) ◽

pp. e043213

Author(s):

Kelley Kilpatrick ◽

Eric Nguemeleu Tchouaket ◽

Maud-Christine Chouinard ◽

Isabelle Savard ◽

Naima Bouabdillah ◽

...

Keyword(s):

Systematic Reviews ◽

Nurse Practitioners ◽

Primary Healthcare ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Outcomes Of Care ◽

Wide Range ◽

Ethical Approval ◽

Role Definitions

IntroductionPrimary healthcare nurse practitioners (PHCNPs) practice in a wide range of clinical settings and with diverse patient populations. Several systematic reviews have examined outcomes of PHCNP roles. However, there is a lack of consistency in the definitions used for the PHCNP role across the reviews. The identification of indicators sensitive to PHCNP practice from the perspective of patients, providers and the healthcare system will allow researchers, clinicians and decision-makers to understand how these providers contribute to outcomes of care.Methods and analysisA review of systematic reviews is proposed to describe the current state of knowledge about indicators sensitive to PHCNP practice using recognised role definitions. Outcomes of interest include any outcome indicator measuring the effectiveness of PHCNPs. We will limit our search to 2010 onwards to capture the most up-to-date trends. The following electronic databases will be searched: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, EMBASE, Global Health, Health Economics Evaluation Database, Health Evidence, HealthStar, Health Systems Evidence, Joanna Briggs Institute, Medline, PDQ-Evidence, PubMed and Web of Science. The search strategies will be reviewed by an academic librarian. Reference lists of all relevant publications will be reviewed. Grey literature will be searched from 2010 onwards, and will include: CADTH Information Services, CADTH’s Grey Matters tool, OpenGrey, Organisation for Economic Co-operation and Development, ProQuest Dissertation and Theses and WHO. The PROSPERO International Prospective Register of Systematic Reviews will be searched to identify registered review protocols. The review protocol was developed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A narrative synthesis will be used to summarise study findings.Ethics and disseminationNo ethical approval is required for the study. The data used in the study will be abstracted from published systematic reviews. Dissemination strategies will include peer-reviewed publication, conference presentations and presentations to key stakeholders.PROSPERO registration numberCRD42020198182.

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Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Nursing Research and Practice ◽

10.1155/2014/170514 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Isabelle Brault ◽

Kelley Kilpatrick ◽

Danielle D’Amour ◽

Damien Contandriopoulos ◽

Véronique Chouinard ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Primary Healthcare ◽

Interprofessional Collaboration ◽

Multiple Case Study ◽

Role Clarity ◽

Primary Care Teams ◽

Essential Components ◽

Multiple Case

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

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Healthcare Provider Perspectives on Bipolar I Disorder Screening and the Rapid Mood Screener (RMS), a Pragmatic, New Tool

CNS Spectrums ◽

10.1017/s1092852921000201 ◽

2021 ◽

Vol 26 (2) ◽

pp. 181-183

Author(s):

Michael E. Thase ◽

Stephen M. Stahl ◽

Roger S. McIntyre ◽

Tina Matthews-Hayes ◽

Mehul Patel ◽

...

Keyword(s):

Depressive Symptoms ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Screening Tool ◽

Positive Impact ◽

Screening Tools ◽

Predictive Values ◽

Bipolar I Disorder ◽

Provider Perspectives ◽

Patient Reported

AbstractIntroductionAlthough mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.MethodsA nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.ResultsAmong HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.DiscussionThe RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.FundingAbbVie Inc.

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How Assisted Living Staff Conceive of Dementia Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2351 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 676-677

Author(s):

Debra Dobbs ◽

Sheryl Zimmerman ◽

Stephanie Miller ◽

Paula Carder ◽

Anna Beeber ◽

...

Keyword(s):

Mixed Methods ◽

Assisted Living ◽

Medication Management ◽

Mixed Methods Study ◽

Organizational Characteristics ◽

Medical Interventions ◽

Person Centered Care ◽

Outcomes Of Care ◽

Centered Care ◽

Care Practices

Abstract For those who provide care to the more than 40% of persons with dementia in assisted living (AL) communities, behavioral expressions (BEs) can be challenging. The objective of this mixed-methods study was to understand how AL staff conceive of BEs and what strategies they use to address them. Staff from 250 AL communities in seven states were asked to describe one successful and unsuccessful case of care. A conceptual model related to antecedents, behaviors, and consequences was developed and expanded to include staff strategies and outcomes of care; organizational characteristics associated with care practices were examined. Anxiety/restlessness, combativeness and resistance to care were the most prevalent BEs. Medical interventions (e.g., inpatient psychiatric assessment, medication management) were used in two-thirds of cases. Person-centered care was used more often in successful cases. Respondents in dementia-only communities identified antecedents to BEs more often than those in other communities.

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Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study

BMC Family Practice ◽

10.1186/s12875-018-0746-1 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 8

Author(s):

Marleen H. Lovink ◽

Anneke J. A. H. van Vught ◽

Anke Persoon ◽

Lisette Schoonhoven ◽

Raymond T. C. M. Koopmans ◽

...

Keyword(s):

Qualitative Study ◽

Older People ◽

General Practitioners ◽

Nurse Practitioners ◽

Primary Healthcare ◽

Physician Assistants ◽

Skill Mix

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Willingness to Stop Smoking: A Cross-Sectional Study of a Primary Healthcare Center Visitors’ in an Urban Area of Alexandria in Egypt

10.31219/osf.io/enyxw ◽

2020 ◽

Author(s):

Rehab A. Rayan

Keyword(s):

Smoking Cessation ◽

Urban Area ◽

Primary Healthcare ◽

Health Hazard ◽

Single Point ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Stop Smoking

For improving accomplished attempts to stop smoking, it is necessary to learn about the qualities of individuals who can willingly stop smoking. This study seeks to discover the willingness degree and associated determinants to stop smoking between adult visitors of a primary healthcare centre in an urban area of Alexandria in Egypt. In this single point and descriptive cross-sectional study, a semi-structured questionnaire was distributed to a sample of 53 adults aged ≥18 years in May 2019. Descriptive statistical analyses were conducted to evaluate the determinants influencing the willingness to stop smoking. Of the 53 respondents (with a mean age of 38.7 years old), 41.5% of them were males. Almost 18.9% of the respondents were ongoing smokers (36.4% of males and 6.5% of females), though 83.7% of those smokers were willing to stop smoking. The number of male smokers was significantly greater than female smokers (Pearson Chi-Square = 7.52, p-value = 0.006). Determinants, which can favourably influence the willingness to stop smoking, were believing that smoking is a health risk to them (100%) and the others around (94.3%). A bulk of participants (56.6%) doubted the need for nicotine supplements to help in smoking cessation. Smoker respondents were willing to stop smoking. Understanding that smoking is a health hazard for both smokers and the others around can motivate smoking cessation. Relying on nicotine supplements alone might not add favourably to a strong smoking cessation decision. Tailoring campaigns to raise awareness about smoking health hazards’ would support and sustain smoking cessation.

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