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Rhian Parker, ANU: The Effectiveness Of Nurse Practitioners In Primary Care: What Does International Evidence Tell Us?
 

Rhian Parker, ANU: The Effectiveness Of Nurse Practitioners In Primary Care: What Does International Evidence Tell Us?

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Rhian Parker, Associate Professor Australian Primary Health Care Research institute, Australian National University delivered this presentation at the 2013 Developing the Role of the Nurse ...

Rhian Parker, Associate Professor Australian Primary Health Care Research institute, Australian National University delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconference

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    Rhian Parker, ANU: The Effectiveness Of Nurse Practitioners In Primary Care: What Does International Evidence Tell Us? Rhian Parker, ANU: The Effectiveness Of Nurse Practitioners In Primary Care: What Does International Evidence Tell Us? Presentation Transcript

    • The Effectiveness Of Nurse Practitioners In Primary Care: What Does International Evidence Tell Us? Associate Professor Rhian Parker CRICOS #00212K
    • Overview Describe • The effectiveness of nurse led primary care interventions; • The effectiveness of nurses in chronic disease management, illness prevention and health promotion; • Patient satisfaction with and acceptance of nurse-led care; • Whether nurse-led models can improve effectiveness and reduce costs. CRICOS #00212K
    • Effectiveness of nurse led primary care interventions • Terminology not consistent across countries • Two main areas of review- nurses working as substitutes for doctors and nurses working as supplements to doctors CRICOS #00212K
    • Working as substitutes-Systematic Reviews • Quality of care similar for doctors and NPs (Laurant et al) • NPs were found to provide more health advice and achieved higher levels of patient satisfaction compared to doctors (Flynn et al) • Not clear if NPs decreased the workload of doctors or whether increased use of extra services and tests by nurses negated salary cost savings (Laurant et al) • NPs provide longer consultations and carry out more investigations than doctors (Horrocks et al). CRICOS #00212K
    • Working as Supplements-Systematic Reviews • Modest evidence that NPs in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors (Keleher et al) • Nurse-collaborative care (with doctors) is better than care provided by doctors alone (Newhouse et al). CRICOS #00212K
    • Condition specific care-Systematic Reviews • Asthma- nurse led clinic modest evidence to support their efficacy and recommended further trials be carried out (Baishnab and Karner) • Diabetes- favourable patient outcomes resulted from the addition of patient education delivered by nurses (Renders et al) • CHD- care equivalent to non-nurse-managed clinics and no greater risk of poorer outcomes (Schadewaldt and Schultz) CRICOS #00212K
    • Condition specific care-Systematic Reviews • Smoking cessation- Nursing interventions were compared to usual care or to a control in 31 studies and intervention was found to significantly increase the likelihood of quitting (Rice and Stead) • Obesity- nurses affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change, and quality of life (Sargent, Forrest, Parker) CRICOS #00212K
    • Cost Effectiveness-Systematic Reviews • Recent systematic review demonstrates nurse-led models can improve effectiveness and reduce costs; findings not echoed in earlier systematic reviews. • Authors caution the generalisability of cost-effectiveness studies to other countries and health systems and that the direct comparability and applicability of studies in one area to another health system may not be easily evaluated (Browne et al) CRICOS #00212K
    • Results of various randomised controlled trials (RCTs)  Adding nurse practitioners to a GP team did not reduce workload of GP in the short term as they often discovered patients had unrecognised problems  Nurse practitioners improved the quality of care for patients during surgery hours which may have reduced out of hours call outs Nurse practitioners provide equivalent care to doctors within their scope of practice Nurse practitioners provide equal and often higher levels of patient satisfaction Nurse practitioners provide longer consultations Nurse practitioners provide more follow-up consultations No significant differences in patterns of prescribing between nurse practitioners and GPs Nurse practitioners ordered equal and often more investigations Nurse practitioners provide more information about illnesses        CRICOS #00212K
    • Hard to reach populations • Alcohol & drug dependency- growing role of specialist nurses provide expert knowledge and guidance for primary care staff in effectively managing patients with dependencies • Mental health- Nurse-led collaborative care in a primary care setting has been shown to be effective in the area of mental health for treatment of depression in Australia and England and for identifying physical health issues in mentally ill patients in Scotland CRICOS #00212K
    • Rural and remote populations • 32% of Australians live outside major cities  A nurse-led caravan park outreach project in Maitland (NSW) provides care for the vulnerable  Victorian Bush Nursing Centres in Walwa and Harrow provide quality care  A nurse practitioner based in Port Macquarie (NSW) reduces hospital admissions of elderly- estimate by D o H NSW savings of $1.5 million in hospital admissions for over 65s. CRICOS #00212K
    • Consumer perceptions of NPs • Australian consumers have a mixed understanding of nurse practitioners’ role in primary health care and that they are unsure of their scope of practice • Consumers also unsure of the role delineation between GPs and nurse practitioners • Consumers positive about consulting nurse practitioners for primary health care eg minor illnesses and injuries reproductive concerns and consult GPs about more serious clinical problems • The Australian community need to be better informed about, and have a better understanding of, nurse practitioners’ qualifications, scope of practice and role within primary health care (Parker et al). CRICOS #00212K
    • Overview • Good international evidence that nurses working in primary care provide effective care, achieve good patient compliance and patient satisfaction • Nurses can provide equivalent care to doctors but have longer consultations and order more diagnostic tests • Lifestyle interventions delivered by nurses have been shown to be effective for smoking cessation, diabetes care, cardiac care and obesity. Nurse-led care has been shown to be acceptable to GPs and patients. CRICOS #00212K
    • • Recent Canadian (Browne et al) review found nurse-led models can improve effectiveness and reduce costs; findings not echoed in earlier systematic reviews although the authors caution that these findings on costeffectiveness may not be generalisable to other countries and health systems • A broader role for endorsed primary care NPs in Australia is feasible and consumers are accepting of NPs providing a range of primary care services. CRICOS #00212K
    • References 1.Flynn K. Systematic reviews for nurse-led primary care. Boston. MA: Veterans Health Administration Office of Patient Care Services Technology Assessment Program; 2009. 2.Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev [serial on the Internet]. 2004; (4) 3.Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 2002 Apr 6;324(7341):819-23. 4.Keleher H, Parker R, Abdulwadud O, Francis K. Systematic review of the effectiveness of primary care nursing. Int J Nurs Pract. 2009 Feb;15(1):16-24. 5.Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: A systematic review. Nurs Econ. 2011;29(5):230-50. 6.Baishnab E, Karner C. Primary care based clinics for asthma. Cochrane Database Syst Rev [serial on the Internet]. 2012; (4): Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003533/frame.html. 7.Renders Carry M, Valk Gerlof D, Griffin Simon J, Wagner E, van Eijk Jacques Th M, Assendelft Willem JJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev [serial on the Internet]. 2000; (4) 8.Schadewaldt V, Schultz T. Nurse-led clinics as an effective service for cardiac patients: Results from a systematic review. Int. [Review]. 2011 Sep;9(3):199-214. 9.Rice VH, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Syst Rev. [Meta-analysis review]. 2008(1):CD001188. 10.Sargent G, Forrest L, Parker R, Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review, Obesity Volume 13, Issue 12, December 2012, Pages: 1148– 1171, CRICOS #00212K
    • 11.Parker R, Forrest L, McCracken J, McRae I, Cox D. What primary health-care services are Australian consumers willing to accept from nurse practitioners? A National Survey. Health Expectations. 2012 (in press). 12.Parker R, Forrest L, Ward N, McCracken J, Cox D. How acceptable are primary health care nurse practitioners to Australian consumers? Collegian. 2012;doi: 10.1016/j.colegn.2012.03.001 13.Browne G, Birch S, Thabane L. Better care: An analysis of nursing and healthcare system outcomes. Ottawa, Canada: Canadian Health Services Research Foundation; 2012. CRICOS #00212K
    • Thank You rhian.parker@canberra.edu.au CRICOS #00212K