Pre-Post Analysis of the Impact of British Columbia Nurse Practitioner Primary Care Clinics on Patient Health and Care Experience

Abstract

Objective: This study aims to evaluate the impact of a primary care nurse-practitioner-led clinic model piloted in British Columbia (Canada) on patients' health and care experience. Design: The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-Led clinics. The pre-rostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic. Setting: To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from core urban to peri rural. Participants: Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected. Primary outcome measures: The survey instrument was focused on five core dimensions of patients' primary care experience (accessibility, continuity, comprehensiveness, responsiveness, and outcomes of care) as well as on the SF-12 Short-form Health Survey. Results: Scores for all dimensions of patients' primary care experience increased significantly: Accessibility (T0=5.9, T1=7.9, p<0.000), Continuity (T0=5.5, T1=8.8, p<0.000), Comprehensiveness (T0=5.6, T1=8.4, p<0.000), Responsiveness (T0=7.2, T1=9.5, p<0.000), Outcomes of care (T0=5.0, T1=8.3, p<0.000). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.000) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709). Conclusions: Our results suggest that the NP-Led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.