scholarly journals Perceptions of underlying practice hierarchies: Who is managing my care?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tara N Officer ◽  
Karen McBride-Henry
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Professional ◽  
Health System ◽  
Nurse Practitioner ◽  
Health Service Delivery ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Primary Health ◽  
Optimal Health

Abstract Background The introduction of new health professional roles, such as that of the nurse practitioner and pharmacist prescriber in primary health care can lead to changes in health service delivery. Consumers, having used these roles, often report high satisfaction. However, there is limited knowledge of how these individuals position nurse practitioner and pharmacist prescriber roles within existing practice structures. Methods Semi-structured interviews were conducted with 21 individuals receiving services from these practitioners in New Zealand primary health care. Interviews were recorded and transcribed verbatim for thematic analysis. Results Participant views reflect established practice hierarchies, placing advanced practitioners ‘below’ general practitioners. Participants are unable to articulate what it was about these practitioners that meant they operated at lower tiers and often considered practitioners to act as ‘their doctor’. They also highlight structural barriers impairing the ability of these providers to operate within their full scope of practice. Conclusions While seeing value in the services they receive, consumers are often unable to position nurse practitioner and pharmacist prescriber roles within health system contexts or to articulate how they value their practitioner’s skills. Embedded structural barriers may be more visible to consumers than their interactions with the health system suggest. This may influence peoples’ ability to receive intended or optimal health services. Consumer ‘health professional literacy’ around the functions of distinct health practitioners should be supported so that they may make informed service provision choices.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

scholarly journals ‘She taught me’: factors consumers find important in nurse practitioner and pharmacist prescriber services

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tara N. Officer ◽  
Jackie Cumming ◽  
Karen McBride-Henry
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Consumer Satisfaction ◽  
Care Delivery ◽  
Realist Evaluation ◽  
Structured Interviews ◽  
Primary Health ◽  
Advanced Practitioner

Abstract Background Advanced practitioner services, such as those nurse practitioners and pharmacist prescribers provide, are an opportunity to improve health care delivery. In New Zealand, these practitioners remain underutilised, despite research suggesting they offer safe and effective care, and considerable international literature recording patient satisfaction with these roles. This study aimed to explore factors underlying consumer satisfaction with primary health care nurse practitioner and pharmacist prescriber services. Methods As part of a larger realist evaluation, 21 individuals receiving advanced practitioner services participated in semi-structured interviews. These interviews were transcribed and coded against context–mechanism–outcome configurations tested and refined throughout the research. Results Study findings emphasise the importance of consumer confidence in the provider as a mechanism for establishing advanced practitioner roles. Underlying this confidence is a recognition that these practitioners work in a more accessible manner, engage at the individual’s ‘level’, and operate with passion. Conclusions This research offers learnings to re-engineer service delivery within primary health care to make best use of the entire health care team by including consumers in the design and introduction of new roles.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

scholarly journals ‘She Taught Me’: Factors Consumers Find Important in Nurse Practitioner and Pharmacist Prescriber Services

2020 ◽  
Author(s):  
Tara Officer ◽  
Jackie Cumming ◽  
Karen McBride-Henry
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Consumer Satisfaction ◽  
Care Delivery ◽  
Realist Evaluation ◽  
Structured Interviews ◽  
Primary Health ◽  
Advanced Practitioner

Abstract Background: Advanced practitioner services, such as those nurse practitioners and pharmacist prescribers provide, are an opportunity to improve health care delivery. In New Zealand, these practitioners remain underutilised, despite research suggesting they offer safe and effective care, and considerable international literature recording patient satisfaction with these roles. This study aimed to explore factors underlying consumer satisfaction with primary health care nurse practitioner and pharmacist prescriber services.Methods: As part of a larger realist evaluation, 21 consumers of advanced practitioner services participated in semi-structured interviews. These interviews were transcribed and coded against context-mechanism-outcome configurations tested and refined throughout the research.Results: Study findings emphasise the importance of consumer confidence in the provider as a mechanism for establishing advanced practitioner roles. Underlying this confidence is a recognition that these practitioners are more accessible, engage at the consumer’s ‘level’, and operate with passion.Conclusions: This research offers learnings to re-engineer service delivery within primary health care to make best use of the entire health care team by including consumers in the design and introduction of new roles.

scholarly journals Portugal's primary health care human resources assessment

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Oliveira Miranda ◽  
P Santos Luis ◽  
M Sarmento
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Family Medicine ◽  
Human Resources ◽  
Health Professional ◽  
Health Care Services ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
The Mean

Abstract Background Primary health care services are the cornerstone of all health systems. Having clear data on allocated human resources is essential for planning. This work intended to map and compare the primary health care human resources of the five administrative regions (ARS) of the Portuguese public health system, so that better human resources management can be implemented. Methods The chosen design was a descriptive cross sectional study. Each of the five ARS were divided into primary health care clusters, which included several primary health care units. All of these units periodically sign a “commitment letter”, where they stand their service commitments to the covered population. This includes allocated health professionals (doctors, nurses), and the information is publicly accessible at www.bicsp.min-saude.pt. Data was collected for 2017, the year for which more commitment letters were available. Several ratios were calculated: patients/health professional; patients/doctor (family medicine specialists and residents); patients/nurse and patients/family medicine specialist. Mean, standard deviation, minimum and maximum values were calculated. Results National patients/health professional ratio was 702 with the mean of the 5 ARS calculated at 674+-7.15% (min 619, max 734) whilst the national patients/doctor ratio was 1247 with the mean of the 5 ARS calculated at 1217+-7.17% (min 1074, max 1290). National patients/nurse ratio was 1607 with the mean of the 5 ARS calculated at 1529+-13.08% (min 1199, max 1701). Finally, national patients/family medicine specialist ratio was 1711 with the mean of the 5 ARS calculated at 1650+-6,36% (min 1551, max 1795). Conclusions Human resources were differently spread across Portugal, with variations between the five ARS in all ratios. The largest differences occur between nursing staff, and may translate into inequities of access, with impact on health results. A more homogeneous human resources allocation should be implemented. Key messages Human resources in the Portuguese primary health care services are not homogeneously allocated. A better and more homogeneous allocation of human resources should be implemented to reduce access health inequities.

scholarly journals Management of pharmaceutical services in the Brazilian primary health care

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Letícia Farias Gerlack ◽  
Margô Gomes de Oliveira Karnikowski ◽  
Camila Alves Areda ◽  
Dayani Galato ◽  
Aline Gomes de Oliveira ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Pharmaceutical Services ◽  
Limiting Factors ◽  
Health Board ◽  
Complex Samples ◽  
Financial Autonomy ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening

scholarly journals Access to medicines by patients of the primary health care in the Brazilian Unified Health System

2017 ◽  
Vol 51 ◽  
pp. 20s ◽  
Author(s):  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Vânia Eloisa de Araújo ◽  
Alessandra Maciel Almeida ◽  
Carolina Zampirolli Dias ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Developed Countries ◽  
Access To Medicines ◽  
Essential Medicines ◽  
Unified Health System ◽  
Primary Health ◽  
Significant Difference ◽  
Good For

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population

scholarly journals Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Borges Costa ◽  
C Salles Gazeta Vieira Fernandes ◽  
T Custódio Mota ◽  
E Torquato Santos ◽  
M Moura de Almeida ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Assessment Tool ◽  
Health Coverage ◽  
Access To Health Services ◽  
Primary Health ◽  
Care Assessment ◽  
The City

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

scholarly journals Modeling of Food and Nutrition Surveillance in Primary Health Care

2017 ◽  
Vol 30 (1) ◽  
pp. 109-126 ◽  
Author(s):  
Santuzza Arreguy Silva VITORINO ◽  
Marly Marques da CRUZ ◽  
Denise Cavalcante de BARROS
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care System ◽  
Document Analysis ◽  
Logic Model ◽  
Structured Interviews ◽  
Primary Health ◽  
Food And Nutrition ◽  
Definition Of ◽  
Care System

ABSTRACT Objective: To describe the modeling stages of food and nutrition surveillance in the Primary Health Care of the Unified Health Care System, considering its activities, objectives, and goals Methods: Document analysis and semi-structured interviews were used for identifying the components, describe the intervention, and identify potential assessment users. Results: The results include identification of the objectives and goals of the intervention, the required inputs, activities, and expected effects. The intervention was then modeled based on these data. The use of the theoretical logic model optimizes times, resources, definition of the indicators that require monitoring, and the aspects that require assessment, identifying more clearly the contribution of the intervention to the results Conclusion: Modeling enabled the description of food and nutrition surveillance based on its components and may guide the development of viable plans to monitor food and nutrition surveillance actions so that modeling can be established as a local intersectoral planning instrument.

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