Outcomes associated with family nurse practitioner practice in fee-for-service community-based primary care




Roots, Alison Claire

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The formalized nurse practitioner (NP) role in British Columbia is relatively new with the majority of roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners (GP) and difficulties with recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow with challenges in understanding the extent of its contributions. This study was to identify the impacts and outcomes associated with the NP role in collaborative primary care practice. Multiple case studies where NPs were embedded into rural fee-for-service practices were undertaken to determine the outcomes at the practitioner, practice, community, and health services levels. Interviews, documents, and before and after data, were utilized to identify changes in practise, access, and acute care service utilization. The results showed that NPs affected how care was delivered, particularly through the additional time afforded each patient visit, the development of a team approach with interprofessional collaboration, and a change in style of practise from solo to group practise. This resulted in improved physician job satisfaction. Patient access to the practice improved with increased availability of appointments and practice staff experienced improved workplace relationships and satisfaction. At the community level, access to primary care improved for harder to serve populations and new linkages developed between the practice and their community. The acute care services experienced a statistically significant decrease in emergency use and admissions to hospital (p= .000). The presence of the NP improved their physician colleagues desire to remain in their current work environment. This study identified the diversity of needs that can be addressed by the NP role; the importance of time to enhance patient care, and its associated benefits, especially in the fee-for-service model; the value of the NP’s role in the community; the acceptance of the clinical competence of NPs by their physician colleagues; the outcomes generated at the practice level in terms of organizational effectiveness and service provision; and substantiated the impact of the role in improving primary care access and reducing acute care utilization.



primary care nurse practitioner, outcomes, rural practice, case study