Assessing clinical support and inter-professional interactions among front-line primary care providers in remote communities in northern Canada: a pilot study

Abstract

BackgroundPrimary care in remote communities in northern Canada is delivered primarily by nurses who receive clinical support from physicians in regional centres and the patient transportation system. To improve continuity, quality and access to care in remote northern communities, it is important to understand the perspectives of front-line providers and the complex challenges they face.ObjectiveTo design and implement a survey of primary care providers to identify issues relating to inter-professional communication, clinical support and patient evacuation.MethodsIn collaboration with the territorial government and regional health authority partners, we developed a 21-item self-administered questionnaire survey, which could be completed online. The survey was sent to 218 physicians and nurses who were employed in the Northwest Territories (NWT) at the time of the survey and were involved in sending patients out of the community and/or receiving patients. The survey also contained an open-ended question at the end seeking comments regarding primary health care.ResultsThe overall low response rate of 39% among nurses and 19% among physicians threatens the validity of the quantitative results. The majority of providers were satisfied with their ability to communicate with other providers in a timely manner, their freedom to make clinical decisions and their overall experience practicing in the NWT. The patient transfer system appears to work from both the sender and receiver perspectives. However, a common theme reported by nurses was that physicians providing clinical advice, especially short-term locums, were not familiar with the local situation, whilst physicians at the receiving end remarked that the clinical information provided to them often lacked clarity.ConclusionsImportant lessons were learnt from the pilot study, especially in better engagement of providers in planning and dissemination. The questionnaire design and the online method of delivery were acceptable. Although important issues were identified, a larger definitive survey is needed to investigate them in the future.

The quality and safety of locum doctors: a narrative review

“…Other papers examined locum medical practice in settings such as anaesthesia, 23 primary care 24–26 and hospital medicine, 22 and some explored doctors' attitudes to and experience of locum working. 27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety.…”

“…27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety. 22–25,27,28 This was attributed in part to locum doctors being less likely to be familiar with patients and less aware of local policies and processes, 25 which had a number of consequences, including delays in discharging patients 26 and safety procedures being less likely to be carried out. 23 There was some qualitative evidence to suggest that working with locums was viewed unfavourably by other doctors as their lack of familiarity could be burdensome for other healthcare professionals, who reported having to work outside of their scope of practice in order to compensate for locum unfamiliarity with local contexts.…”

“…23 There was some qualitative evidence to suggest that working with locums was viewed unfavourably by other doctors as their lack of familiarity could be burdensome for other healthcare professionals, who reported having to work outside of their scope of practice in order to compensate for locum unfamiliarity with local contexts. 26 Locum working was sometimes regarded as a problematic solution to staffing problems that had potential quality issues. 27…”

Evaluation of a new medical retrieval and primary health care advice model in Central Australia: Results of pre‐ and post‐implementation surveys

“…Pre‐ and post‐implementation surveys were adapted from a survey originally developed in Canada 17 . Data collected included demographic characteristics (age, gender) and professional characteristics (location of health care duties, current role and nature of employment) of respondents.…”

“…Pre-and post-implementation surveys were adapted from a survey originally developed in Canada. 17 Data collected included demographic characteristics (age, gender) and professional characteristics (location of health care duties, current role and nature of employment) of respondents. The surveys contained thirty questions that collected data across three domains: clinical support and guidance; remote retrieval service; and PHC in the Northern Territory (NT).…”