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 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 ‘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 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 Nurse practitioner consultations in primary health care: a case study-based survey of patients’ pre-consultation expectations, and post-consultation satisfaction and enablement

2018 ◽  
Vol 20 ◽  
Author(s):  
Julian Barratt ◽  
Nicola Thomas
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Primary Health Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Convenience Sample ◽  
Primary Health ◽  
Communication Processes ◽  
Consultation Time

AbstractBackgroundResearch has not yet fully investigated links to consultation duration, patient expectations, satisfaction, and enablement in nurse practitioner consultations. This study was developed to address some of these research gaps in nurse practitioner consultations, particularly with a focus on expectations, satisfaction, and enablement.AimTo explore the influence of pre-consultation expectations, and consultation time length durations on patient satisfaction and enablement in nurse practitioner consultations in primary health care.DesignSurvey component of a larger convergent parallel mixed methods case study designed to conjointly investigate the communication processes, social interactions, and measured outcomes of nurse practitioner consultations. The survey element of the case study focusses on investigating patients’ pre-consultation expectations and post-consultation patient satisfaction and enablement.MethodsA questionnaire measuring pre-consultation expectations, and post-consultation satisfaction and enablement, completed by a convenience sample of 71 adults consulting with nurse practitioners at a general practice clinic. Initial fieldwork took place in September 2011 to November 2012, with subsequent follow-up fieldwork in October 2016.ResultsRespondents were highly satisfied with their consultations and expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (P=0.003). A significant, small to moderate, positive correlation of 0.427 (P=0.005) between general satisfaction and enablement was noted. No significant correlation was seen between consultation time lengths and satisfaction or enablement.ConclusionHigher levels of patient enablement and satisfaction are not necessarily determined by the time lengths of consultations, and how consultations are conducted may be more important than their time lengths for optimising patient satisfaction and enablement.

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

2020 ◽  
pp. 152715442096553
Author(s):  
Sue Adams ◽  
Jenny Carryer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Nurse Practitioner ◽  
Central Government ◽  
Health Sector ◽  
District Health ◽  
Policy Context ◽  
Primary Health

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand’s strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a “hands-off” approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

McAtee and Silver Reply

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 620-621
Author(s):  
Patricia A. McAtee ◽  
Henry K. Silver
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Personalized Care ◽  
Primary Health ◽  
Primary Health Services ◽  
Better Than

We appreciate the commentary of Dr. Austin regarding our article. The nurse practitioner role was created because the needs of children for primary health care were not being adequately met through the existing health care delivery system. Pediatricians who practice with nurse practitioners have found that the pediatrician and the nurse can provide more primary health services to children and can give more personalized care than they previously were able to do. Acceptance by patients and their parents has been excellent; more than one half of the parents indicated that joint care was better than that received from the same pediatrician alone.

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