Practice activities of privately‐practicing nurse practitioners: Results from an Australian survey

Helms

Journal of Advanced Nursing

et al. 2020

Aim To achieve profession‐wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties). Design Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three‐round Delphi study (Survey Phase). Methods Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in‐depth interviews of purposeful sample of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web‐based Delphi surveys), with draft standards reviewed profession‐wide. Responses comprised scoring using Likert scales to calculate content validity indexes for individual standards with qualitative responses supporting decision‐making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of individual and group feedback. The study was conducted 2014–2017. Results Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy‐three standards were validated, with final content validity indices of 92–100%. Scale‐level indices were 98%, strongly validating metaspecialty taxonomy. Conclusion A research‐derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education. Impact The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 64%

Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study

Helms

Journal of Advanced Nursing

et al. 2020

“…In the national survey data relating to PPNPs' practice activities, only 59% of PPNPs (n = 43) perceived that they worked to the full scope of their practice as a PPNP. 15 The issues affecting the capacity of PPNPs to complete an episode of patient care identified in the present study are the time-based structure of the MBS, limited access to investigative and procedural MBS items, the inability to refer to allied health professionals through the MBS and medications listed as CTO and SCM on the PBS and those listed in the Repatriation Pharmacuetical Benefits Schedule.…”

Section: Capacity Of Ppnps To Provide Complete Episodes Of Carementioning

confidence: 88%

“…The purpose of the present study was to understand how and why PPNP MBS reimbursement processes impact on patient access to care. Survey results relating to workforce characteristics, 14 collaborative arrangements 10 and practice activities 15 have been published previously. Results related to the interviews with PPNPs have not yet been published.…”

Section: Introductionmentioning

confidence: 99%

Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey

Currie¹,

Chiarella²,

Buckley³

2019

Aust. Health Review

Self Cite

Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

Journal of Clinical Nursing

“…The MBS and PBS are Australia's universal health funding systems for consultations, investigations and medications to patients receiving care in community settings (Services Australia, 2022a; Services Australia, 2022b). Access to the MBS and PBS is fundamental to NPs' provision of subsidised community healthcare (Currie et al., 2018).…”

Section: Methodsmentioning

confidence: 99%

Nurse practitioner led telehealth services: A scoping review

Charalambous,

Hollingdrake,

Currie

2023

Self Cite

AimTo explore the educational preparation of nurse practitioners to deliver telehealth services and their impact on access to care.DesignScoping review.MethodsA search was undertaken 4 April 2022. Primary studies that focused on nurse practitioners and their patients/clients engaging in telehealth services in any healthcare setting or clinical area within Australia, New Zealand, United States, Canada, United Kingdom, and Ireland, published between 2010 to 2022, were included. Study findings were analysed using the Levesque et al. (2013) access to care framework and the Patterns, Advances, Gaps, Evidence for Practice and Research Recommendations framework (Bradbury‐Jones et al., 2021). The PRISMA‐ScR checklist was used to guide reporting.Data SourcesCINAHL, Medline, Scopus, and Embase databases.ResultsForty‐two studies were included. Studies (n = 28) relating to access to care focused on appropriateness/ability to engage (n = 14), affordability/ability to pay (n = 1), and availability/ability to reach (n = 13). High levels of telehealth satisfaction were reported, including reduced travel time and costs, and appointment flexibility. Telehealth satisfaction was reduced when a perceived need for physical assessment, or privacy concerns were present. Service providers reported decreased emergency presentations, fewer missed appointments and improved consumer engagement. Fourteen studies related to nurse practitioner education, using a range of approaches such as didactic education modules, simulations and clinical experiences, all published within the past 3 years.ConclusionFindings suggest that nurse practitioner‐led telehealth has improved access to care. High levels of satisfaction indicate patients accept nurse practitioner‐led telehealth. Impacts to healthcare service use and patient engagement further support the viability of nurse practitioner‐led telehealth. The recent increase in telehealth education studies reflects the rapid uptake of telehealth care in the mainstream.Implications for the profession and/or patient carePatients perceive telehealth as acceptable and appropriate to meet their healthcare needs and improve access to care. Telehealth is likely to be a mainstay in ongoing healthcare delivery, therefore, nurse practitioners must have educational preparation to provide telehealth.ImpactThis scoping review provides insight into the ways nurse practitioners deliver telehealth services, how they are educated to provide telehealth services, and their impact on access to care. Nurse practitioner‐led telehealth improves access to care across service provision and consumer perspective domains. Nurse practitioner telehealth education is an emerging topic. This research is valuable for nurse practitioners using telehealth, nurse practitioner educators and telehealth policy decision makers.Reporting MethodPreferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR).Patient or Public ContributionNo Patient or Public Contribution.