GPs’ perceptions of the nurse practitioner role in primary care

Carr, Jacqui; Armstrong, Sarah; Hancock, Beverley; Bethea, Jane

doi:10.12968/bjcn.2002.7.8.10646

Cited by 17 publications

(28 citation statements)

References 9 publications

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“…Some MPs stated that NPs require regular MP supervision [62] and that NPs care for patients who are too complex for the NPs’ skills and knowledge [68]. GPs who worked with a NP were more supportive of NPs performing most tasks without supervision than GPs who worked not with a NP [76]. …”

Section: Resultsmentioning

confidence: 99%

“…Three cross-sectional surveys reported that MPs with previous experience of working with a NP exhibit a more positive attitude towards collaboration with NPs [76-78]. Medical practitioners who had experience in collaborating with a NP were significantly more likely to disagree that NPs provide low-quality primary health care, and more likely to support NP prescribing, consider that NPs can attract new patients, agree that patients accept NPs and believe that NPs free up MP time [77,78].…”

Section: Resultsmentioning

confidence: 99%

“…Medical practitioners who had experience in collaborating with a NP were significantly more likely to disagree that NPs provide low-quality primary health care, and more likely to support NP prescribing, consider that NPs can attract new patients, agree that patients accept NPs and believe that NPs free up MP time [77,78]. In Carr et al’s survey 100% of the GPs who worked with a NP agreed that NP should work in primary health care compared to 89% of the GPs who did not [76]. No qualitative studies investigated those differences.…”

Section: Resultsmentioning

confidence: 99%

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Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care – an integrative review

et al. 2013

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BackgroundThis integrative review synthesises research studies that have investigated the perceptions of nurse practitioners and medical practitioners working in primary health care. The aggregation of evidence on barriers and facilitators to working collaboratively and experiences about the processes of collaboration is of value to understand success factors and factors that impede collaborative working relationships.MethodsAn integrative review, which used systematic review processes, was undertaken to summarise qualitative and quantitative studies published between 1990 and 2012. Databases searched were the Cochrane Library, the Joanna Briggs Institute Library, PubMed, Medline, CINAHL, Informit and ProQuest. Studies that met the inclusion criteria were assessed for quality. Study findings were extracted relating to a) barriers and facilitators to collaborative working and b) views and experiences about the process of collaboration. The findings were narratively synthesised, supported by tabulation.Results27 studies conducted in seven different countries met the inclusion criteria. Content analysis identified a number of barriers and facilitators of collaboration between nurse practitioners and medical practitioners. By means of data comparison five themes were developed in relation to perceptions and understanding of collaboration. Nurse practitioners and medical practitioners have differing views on the essentials of collaboration and on supervision and autonomous nurse practitioner practice. Medical practitioners who have a working experience with NPs express more positive attitudes towards collaboration. Both professional groups report concerns and negative experiences with collaborative practice but also value certain advantages of collaboration.ConclusionsThe review shows that working in collaboration is a slow progression. Exposure to working together helps to overcome professional hurdles, dispel concerns and provide clarity around roles and the meaning of collaboration of NPs and MPs. Guidelines on liability and better funding strategies are necessary to facilitate collaborative practice whether barriers lie in individual behaviours or in broader policies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care – an integrative review

et al. 2013

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“…50,51 Evaluating the ''appropriateness'' of referral to the surgeon is therefore a key consideration in a programme such as the WSSAS. There is emerging evidence that physiotherapists triaging patients referred to surgeons for a variety of musculoskeletal conditions show acceptable agreement with surgeons with respect to diagnosis and management recommendations, including surgical referral.…”

Section: Bath Et Al a Spinal Triage Programme Delivered By Physiothementioning

confidence: 99%

A Spinal Triage Programme Delivered by Physiotherapists in Collaboration with Orthopaedic Surgeons

Bath

Grona

Janzen

2012

Physiotherapy Canada

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Purpose: To describe the characteristics of participants in a physiotherapist spinal triage programme, compare the profiles of patients for whom surgery was and was not recommended by a surgeon, and determine the surgical yield among those referred to surgeons. Methods: Data were collected retrospectively by reviewing charts of people who used the service over a 3-year period (2003)(2004)(2005)(2006). Data from up to1,096 people were used in the analysis; complete data were available for 299 people. Descriptive statistics were used to summarize demographics, clinical features, and management recommendations. Characteristics of those who were and were not recommended for surgery were examined using Pearson's chi-square or Fisher's Exact tests. Results: The majority of 746 participants were classified as ''mechanical spine'' (92.5%), 2.9% were ''other body part,'' 2.5% were ''medical/other,'' and only 2% were classified as ''surgical spine.'' Recommendations for surgery (by a surgeon) were independent of patients' age, sex, duration of symptoms, residence (urban/rural), source of health care funding, and diagnosis. The surgical yield was 80%. Conclusions: Most people were not considered candidates for surgery. Triage assessment by physiotherapists can increase the efficiency of an orthopaedic surgeon's caseload by reducing the number of non-surgical referrals and can thus help to ensure more timely access to appropriate health care.Key Words: collaborative practice; diagnosis; advanced practice; low back pain; spinal triage programme. RÉ SUMÉObjectif : Dé crire les caracté ristiques des participants à un programme de triage en fonction de leurs problè mes à la colonne verté brale, comparer les profils des patients pour qui une chirurgie é tait ou non recommandé e et dé terminer l'é tendue de la chirurgie parmi les personnes dirigé es vers un professionnel de la chirurgie. Mé thode : Les donné es ont é té recueillies ré trospectivement en procé dant à un examen des dossiers de personnes qui ont utilisé le service pendant trois ans (de 2003 à 2006). Des donné es relatives à 1 096 personnes é taient disponibles et des donné es complè tes é taient disponibles pour 299 personnes. Des statistiques descriptives ont é té utilisé es pour ré sumer les donné es dé mographiques, les caracté ristiques cliniques et les recommandations de gestion. Les caracté ristiques des personnes ayant ou non fait l'objet d'une recommandation pour une chirurgie ont é té examiné es à l'aide du test du Khi-carré de Pearson et du test de Fisher. Ré sultats : La majorité des 746 participants ont é té classé s comme « mé canique verté brale » (92,5 %); 2,9 % comme « autres parties du corps »; 2,5 % l'ont é té dans « mé dical/autres » et 2 % ont é té classé s comme « verté bral chirurgical ». Les recommandations pour une intervention (par un chirurgien) é taient formulé es indé pendamment de l'â ge des patients, de leur sexe, de la duré e des symptô mes, de leur milieu (urbain ou rural), de la source de financement des soins de santé dans l...

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“…1,2 Bolstering this trend is the development of new models of primary care practice advocating collaborative teams of diverse clinicians. [3][4][5] Yet, among family physicians, some uncertainty and unease persists about the use of these clinicians, [6][7][8] particularly with regard to quality of care, 9,10 patient satisfaction, 11,12 and fi nancial effi ciency. 13,14 Most randomized clinical trials and observational studies have focused on comparing the quality of care between physicians and NPs, with relatively little published research comparing PAs with either physicians or NPs.…”

Section: Introductionmentioning

confidence: 99%

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

Ohman‐Strickland¹,

Orzano²,

Hudson³

et al. 2008

The Annals of Family Medicine

106

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PURPOSE The aim of this study was to assess whether the quality of diabetes care differs among practices employing nurse-practitioners (NPs), physician's assistants (PAs), or neither, and which practice attributes contribute to any differences in care.METHODS This cross-sectional study of 46 family medicine practices from New Jersey and Pennsylvania measured adherence to American Diabetes Association diabetes guidelines via chart audits of 846 patients with diabetes. Practice characteristics were identifi ed by staff surveys. Hierarchical models determined differences between practices with and without NPs or PAs. RESULTSCompared with practices employing PAs, practices employing NPs were more likely to measure hemoglobin A 1c levels (66% vs 33%), lipid levels (80% vs 58%), and urinary microalbumin levels (32% vs 6%); to have treated for high lipid levels (77% vs 56%); and to have patients attain lipid targets (54% vs 37%) (P ≤.005 for each). Practices with NPs were more likely than physician-only practices to assess hemoglobin A 1c levels (66% vs 49%) and lipid levels (80% vs 68%) (P ≤.007 for each). These effects could not be attributed to use of diabetes registries, health risk assessments, nurses for counseling, or patient reminder systems. Practices with either PAs or NPs were perceived as busier (P = .03) and had larger total staff (P <.001) than physician-only practices.CONCLUSIONS Family practices employing NPs performed better than those with physicians only and those employing PAs, especially with regard to diabetes process measures. The reasons for these differences are not clear. Ann Fam Med 2008;6:14-22. DOI: 10.1370/afm.758. INTRODUCTIONI ncreasingly, nurse-practitioners (NPs) and physician's assistants (PAs) serve as a primary point of contact for patients within primary care practices.1,2 Bolstering this trend is the development of new models of primary care practice advocating collaborative teams of diverse clinicians.3-5 Yet, among family physicians, some uncertainty and unease persists about the use of these clinicians, [6][7][8] particularly with regard to quality of care, 9,10 patient satisfaction, 11,12 and fi nancial effi ciency. 13,14 Most randomized clinical trials and observational studies have focused on comparing the quality of care between physicians and NPs, with relatively little published research comparing PAs with either physicians or NPs. 9,[15][16][17][18] For example, in a study comparing NP and physician performance in the care and attainment of outcomes for patients with diabetes, Lenz et al 19 found signifi cant differences in documentation but not in patient outcomes. Some have argued that NPs may enhance primary care because they are trained specifi cally for health promotion and education. 2,20,21 In fact, Hopkins et al 22 found that compared with physicians, NPs performed better at secondary prevention, assessment, and counseling. QU A L I T Y O F DIA BE T ES C A R E W I T H NP s A ND PA sSakr et al 16 found that patients cared for by NPs received more inf...

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GPs’ perceptions of the nurse practitioner role in primary care

Cited by 17 publications

References 9 publications

Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care – an integrative review

Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care – an integrative review

A Spinal Triage Programme Delivered by Physiotherapists in Collaboration with Orthopaedic Surgeons

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

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