scholarly journals Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

2020 ◽  
Author(s):  
Stefan Gysin ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
Armin Gemperli ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Nurse Practitioners ◽  
Quality Care ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Ageing Population ◽  
Care Needs ◽  
Swiss Primary Care

Abstract Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in order to appraise whether the NP role meets the political and demographic demands in Swiss primary care.Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively.Results Data from 5,210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1,613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70-4.36), multimorbid (OR 1.37; 95%-CI 1.24-1.51; p <0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15-1.42; p <0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72-3.42; p <0.001) and anthropometric data (OR 1.33; 95%-CI 1.09-1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04-1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30-0.41; p <0.001) were prescribed or changed less frequently in NP consultations.Conclusions Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care. NPs could offer care to the growing number of multimorbid, polypharmaceutical elderly, and might relieve work pressure from the GPs. Hence, the NP role has the potential to meet the current political and demographic demands in Swiss primary care. An extended scope of practice, especially prescription rights, could foster further professional practice and role implementation.

scholarly journals Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

2020 ◽  
Author(s):  
Stefan Gysin ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
Armin Gemperli ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Nurse Practitioners ◽  
Quality Care ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Ageing Population ◽  
Care Needs ◽  
Swiss Primary Care

Abstract Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in order to appraise whether the NP role meets the political and demographic demands in Swiss primary care.Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results Data from 5,210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1,613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70-4.36), multimorbid (OR 1.37; 95%-CI 1.24-1.51; p <0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15-1.42; p <0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72-3.42; p <0.001) and anthropometric data (OR 1.33; 95%-CI 1.09-1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04-1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30-0.41; p <0.001) were prescribed or changed less frequently in NP consultations. Conclusions NPs could offer care to the growing number of multimorbid, polypharmaceutical elderly, and might relieve work pressure from the GPs. Hence, the NP role has the potential to meet the current political and demographic demands in Swiss primary care. An extended scope of practice, especially prescription rights, could foster further professional practice and role implementation.

Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Providers of Home Visits: An Exploratory Study of Two Cases

2020 ◽  
Vol 33 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Stefan Gysin ◽  
Iren Bischofberger ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Home Visits ◽  
Patient Characteristics ◽  
Pilot Projects ◽  
Family Practices ◽  
Multimorbid Patients ◽  
High Degree ◽  
Swiss Primary Care

In Swiss primary care, general practitioner (GP) home visits have decreased due to impending GP shortages particularly in rural areas. Nurse practitioners (NP) are newly introduced in family practices and could potentially offer home visits to the increasing number of multimorbid elderly. We analysed consultation data from two pilot projects (Practice A and Practice B) with the goal to measure the frequency and patient characteristics of NP consultations both in the practice and on home visits, and to determine the NPs’ autonomy based on the required GP supervision. In Practice A, 17% of all NP consultations were home visits, in Practice B 51%. In both practices, the NPs saw older patients and reported higher autonomy on home visits compared to consultations in the practice. In Practice A, the NP encountered a higher share of multimorbid patients on home visits than in the practice, and the NP’s proportion of autonomously conducted consultations increased from 0% in the first month to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of consultations after 2 years on the job. These first cases provide some evidence that NPs could reach a relatively high degree of autonomy and might pose a potential solution for the decreasing numbers of GP home visits to multimorbid elderly in Swiss primary care.

Primary Care: The Actual Intelligence Required for Artificial Intelligence to Advance Health Care and Improve Health (Preprint)

2021 ◽  
Author(s):  
Winston R. Liaw ◽  
John M Westfall ◽  
Tyler S Williamson ◽  
Yalda Jabbarpour ◽  
Andrew Bazemore
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Vital Signs ◽  
Patient Privacy ◽  
Conversational Agents ◽  
Care Needs ◽  
Remote Sensors ◽  
Delivery Platform ◽  
And Training ◽  
Improve Health

UNSTRUCTURED With conversational agents triaging symptoms, cameras aiding diagnoses, and remote sensors monitoring vital signs, the use of artificial intelligence (AI) outside of hospitals has the potential to improve health, according to a recently released report from the National Academy of Medicine. Despite this promise, AI’s success is not guaranteed, and stakeholders need to be involved with its development to ensure that the resulting tools can be easily used by clinicians, protect patient privacy, and enhance the value of the care delivered. A crucial stakeholder group missing from the conversation is primary care. As the nation’s largest delivery platform, primary care will have a powerful impact on whether AI is adopted and subsequently exacerbates health disparities. To leverage these benefits, primary care needs to serve as a medical home for AI, broaden its teams and training, and build on government initiatives and funding.

Practice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse Practitioners

2020 ◽  
pp. 107755872097453
Author(s):  
Hayley D. Germack ◽  
Jordan Harrison ◽  
Lusine Poghosyan ◽  
Grant R. Martsolf
Keyword(s):  
Primary Care ◽  
Rural Communities ◽  
Nurse Practitioners ◽  
Practice Patterns ◽  
Quality Care ◽  
Work Environments ◽  
Independent Practice ◽  
Job Outcomes ◽  
High Quality ◽  
Rural And Urban

As nurse practitioners (NPs) are increasingly relied on to deliver primary care in rural communities, it is critical to understand the contexts in which they work and whether they are characterized by work environments and infrastructures that facilitate the provision of high-quality patient care. This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington. While rural and urban NPs have a number of similarities in terms of demographic characteristics, practice patterns, and job outcomes, they also have noteworthy differences. Rural NPs report higher levels of independent practice, fewer structural capabilities that facilitate quality care, and poorer relationships with physicians. Health care organizations in rural communities may need to invest in work environments and infrastructures that facilitate high-quality care and autonomous practice for NPs.

scholarly journals Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review

2018 ◽  
Vol 19 (5) ◽  
pp. 424-447 ◽  
Author(s):  
Dorijn F.L. Hertroijs ◽  
Arianne M.J. Elissen ◽  
Martijn C.G.J. Brouwers ◽  
Nicolaas C. Schaper ◽  
Dirk Ruwaard
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Longitudinal Studies ◽  
Integrated Care ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Related Effect ◽  
Care Needs ◽  
Cross Sectional

AimTo identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.BackgroundIntegrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.MethodsPubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.FindingsIn total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.

Understanding the Fontan Procedure in Congenital Heart Disease Patients and the Importance of Early Hepatology Referrals: A Case Study

2018 ◽  
Vol 11 (2) ◽  
pp. 95-99
Author(s):  
Alice Chan
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nurse Practitioners ◽  
Congenital Heart ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fontan Procedure ◽  
Early Screening

Background: Patients with congenital heart disease are surviving into adulthood because of new surgeries developed over the recent decades. One surgery is the Fontan procedure, which is used in patients with only one functioning ventricle. Although it has been saving lives, in the recent years multiple complications have been noted. Objective: To discuss the Fontan procedure and inform nurse practitioners in the primary care setting the importance of early screening and referral because of increasing number of liver complications in these patients. This case study highlights the dilemmas a patient with the Fontan procedure faces as a young adult. Methods: Evidence-based articles from the PubMed and Embase databases were used to support the case study. Results: Patients with the low-pressure Fontan circulation are under chronic passive congestion and have known liver complications such as liver fibrosis, cirrhosis, and protein-losing enteropathy. This can lead to a high-risk dual organ heart–liver transplant. Conclusions: Early screening and referral to a hepatologist are critical in these patients. Implications for Nursing: Since patients with congenital heart disease often present to the primary care setting, nurse practitioners in this area should understand the Fontan procedure and its associated complications so they can effectively manage these patients.

Palliative Care in Nephrology

2020 ◽  
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Nurse Practitioners ◽  
Quality Care ◽  
Physician Assistants ◽  
Care Needs ◽  
Patient Centered ◽  
Medical Practitioners ◽  
Seriously Ill Patients

Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the core palliative knowledge and skills needed to deliver high value, high quality care for seriously ill patients with chronic and end-stage kidney disease. Chapters are written by a team of international leaders in kidney palliative care and are organized into sections exploring unmet supportive care needs, palliative care capacity, patient-centered care, enhanced support at the end of life, and more. Chapter topics are based on the Coalition for Supportive Care of Kidney Patients Pathways Project change package of 14 evidence-based best practices to improve the delivery of palliative care to patients with kidney disease. An overview of the future of palliative care nephrology with attention to needed policy changes rounds out the text. Palliative Care in Nephrology is an ideal resource for nephrologists, nurses, nurse practitioners, physician assistants, social workers, primary care clinicians, and other practitioners who wish to learn more about integrating individualized, patient-centered palliative care into treatment of their patients with kidney disease.

A Patient With Abnormal Menses: Case Study of a Nurse Practitioner’s Approach to Diagnosis and Management of von Willebrand Disease

2016 ◽  
Vol 22 (2) ◽  
pp. 101-105
Author(s):  
Mirella Vasquez Brooks ◽  
D. Michael Brooks ◽  
Shirley Alvaro
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Blood Clotting ◽  
Von Willebrand Disease ◽  
Diagnostic Workup ◽  
Diagnosis And Management ◽  
Ongoing Care ◽  
Von Willebrand

Von Willebrand disease (vWD) is an inherited disorder that slows and hinders the blood clotting process. The literature on evaluation, diagnosis, and referral of vWD for nurse practitioners working in primary care is scant. This article presents the history and pathophysiology of vWD and a case study of an individual with vWD, including diagnostic workup, appropriate referral to a hematologist, and ongoing care.

scholarly journals Nurse practitioners in Swiss family practices as potentially autonomous providers of home visits: an exploratory study

2019 ◽  
Author(s):  
Stefan Gysin ◽  
Iren Bischofberger ◽  
Rahel Meier ◽  
Anneke van Vught ◽  
Christoph Merlo ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Work Experience ◽  
Home Visits ◽  
Postgraduate Education ◽  
Coding System ◽  
Family Practices ◽  
Swiss Primary Care

Abstract Background Swiss primary care is challenged by impending shortages of general practitioners (GPs) in rural areas and decreasing number of GP home visits. In Anglo-Saxon and many other countries, nurse practitioners (NPs) have been implemented and provide high quality, patient-centred home visits autonomously. In Switzerland, the NP role is new and there are currently only a handful of ongoing pilot projects in family practices. Hence, studies are lacking and data collection is challenging as NPs are not yet registered providers who could be identified in billing or health insurance data. Our aims were to gain insights in the frequency of home visits by NPs in Swiss family practices, and to determine their autonomy based on the required level of GP supervision during consultations.Methods We used consultation data from two pilot practices in rural Switzerland. In “Practice A”, the NP was in postgraduate education and data was gathered electronically between August 2017 and 2018. In “Practice B”, the NP had completed her education, and had two years of work experience as a NP when data was collected manually between April and June 2018. We used a coding system based on five levels of GP supervision to identify NP consultations and home visits, and to determine the NPs’ autonomy in each consultation.Results We analysed data from 1375 consultations. The share of home visits in all NP consultations was 17% in Practice A and 51% in Practice B. Both NPs had a higher share of autonomously conducted consultations during home visits than in the office. In Practice A, the proportion of consultations in which the NP was autonomous increased from 0% in the first month of her employment to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of her consultations.Conclusions After completing postgraduate education with clinical supervision by GPs, and few years of practical experience in their role, NPs can reach a relatively high degree of autonomy and might pose a potential solution to the decreasing numbers of GP home visits in Swiss primary care.

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