INTERLAKE REGIONAL HEALTH AUTHORITY Nurse Practitioner Evaluation

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INTERLAKE REGIONAL HEALTH AUTHORITYNurse
Practitioner Evaluation

• Presentation of Findings

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Background NP Definition

• A registered nurse (RN) with additional
  education in health assessment, diagnosis and
  management of illnesses and injuries, including
  ordering tests and prescribing drugs. i
• i Canadian Nurse Practitioner Initiative,
  http//www.cnpi.ca/documents/pdf/information_sheet
  _1_e.pdf

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Background - NP Initiative Broad Goal

• Improve primary care access for under serviced
  communities.

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Background Specific Goals

• Establish primary care nurse practitioners in 3
  primary care clinics working in collaborative
  practice with physician clinics.
• Provide primary care services in a culturally
  appropriate and sensitive manner.

• Improve health status of under serviced
  communities.
• Extend health care resources such as physician
  access, diabetes education, prenatal and well
  baby services.

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Background Specific Goals

• Enhance access in the Interlake RHA to health
  care services in French.
• Improve the quality of health promotion and
  disease prevention services in the Interlake RHA

• Improve access to primary care screening and
  assessment such as pap tests.
• Promote earlier detection and treatment of
  diseases.

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Background - Focus

• Primary care, prevention and promotion
  initiatives in order to address health outcomes.

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Background Timeline and Activities

• September 2003 - two nurses hired.
• ACTING in NP capacity but not yet licensed.

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Background (contd)

• Funded for two years by the Federal Primary
  Healthcare Transition Fund.

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Background (contd)

• Steering Committee developed.
• Met at least sixteen times over the course of the
  pilot project.
• Ongoing planning, problem solving, partnership
  building, communication with community members
  and healthcare professionals.

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The Evaluation
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Purpose of the Evaluation

• Evaluate the achievement towards meeting the
  Nurse Practitioner (NP) pilot project goals and
  objectives as established by the Interlake
  Regional Health Authority (IRHA).

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Evaluation Framework

• Four main components
• Access
• Quality
• Integration
• Generalizability

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Evaluation Methodology

• First
• Historical review of NP role in several
  countries.

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Evaluation Methodology Data Collection

• Information was gathered through
• Key informant interviews
• Focus groups,
• Written questionnaires
• Telephone interviews
• Review of IRHA data such as satisfaction surveys
  and NP service statistics.

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Groups interviewed

• IRHA staff
• Nurse Practitioner Clients (16 in Focus Groups
  and 31 additional surveyed)

• IRHA Physicians (5)
• Representatives from other Regional Health
  Authorities (3)

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Key Findings
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Findings Literature Review

• NPs generally do well in both quality of care and
  patient satisfaction.
• Common themes regarding both personal
  characteristics and systemic requirements needed
  to implement the NP role successfully.
• Role of NPs is still an emerging area of health
  research in Canada.

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Findings - Access

• Introduction of NPs has considerably increased
  access in under-serviced communities in the
  Interlake region.

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Location of NP visits.
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Age of NP Clients
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Reasons for client visits
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Interventions at NP visits
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Findings - Quality

• High rate of patient satisfaction with quality of
  care.
• NPs were found to spend more time with patients
  and provide more information.
• Positive comments about NPs following up with
  clients with chronic conditions.

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How clients first found out about NP.
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Ranking of NP interactions and services as very
good or excellent, March 2004-2005.
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How likely were clients to book another
appointment with the NP?
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Findings - Integration

• NPs formed a number of partnerships with external
  and IRHA agencies and worked closely with their
  practice advisors.
• Relationship with a consistent practice advisor
  was key to effective integration of NP role.
• Work has been done to further integrate the
  provision of primary care within an
  interdisciplinary model of care.

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Findings Generalizability/Transferability

• Interlake experience underlines the importance of
  RHA leadership in forging relationships in the
  community and among health care professionals to
  facilitate the introduction of NPs into the
  primary care setting.

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Key Accomplishments

• Establishment of a NP model of care in the
  Interlake has been a significant achievement for
  the IRHA.

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Key Accomplishments

• Improved access to primary care services
• Diagnostic and treatment services closer to
  home.

• Communities without service.
• Elderly clients for whom travel is more
  difficult.
• Women in childbearing years.
• Broad variety of medical issues and interventions.

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Key Accomplishments

• Established primary care nurse practitioners in
  more than three primary care clinics.
• Worked in collaborative practice with nearby
  physician clinics.

• Riverton
• Ashern
• Eriksdale
• St. Laurent
• Gypsumville

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Key Accomplishments

• Extended health care resources.

• Physician access
• Diabetes and other chronic disease education
• Prenatal and well baby services
• Inoculations
• Many other services

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Key Accomplishments

• Enhanced access in a francophone community.
• However, service not provided in French.

• Service was very well received in St. Laurent.

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Key Accomplishments

• Improved the quality of health promotion and
  disease prevention services in the IRHA

• Based primarily on satisfaction indicators.
• NP data indicates significant portion of time
  devoted to promotion/prevention and education.

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Key Accomplishments

• Improved access to primary care screening and
  assessment such as PAP tests
• Promoted earlier detection and treatment of
  diseases.

• Community connection and partnership building.
• Ongoing education to patients.
• Pap/pelvic exams and ongoing well-person services.

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Conclusions and Moving Forward

• The next challenge is to fully implement a
  collaborative practice model for primary care
  throughout the region.

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Conclusions and Moving Forward

• The following elements are necessary to implement
  and sustain a collaborative practice model for
  primary care throughout the region

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Moving Forward

• Continued attention to the NP implementation
  process into additional communities will be
  needed from IRHA management.

• The IRHA must continue to provide a leadership
  role.

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Moving Forward

• IRHA must monitor concern about financial
  disincentives that may be affecting the level of
  collaborative practice.
• Information and Communication Technology is an
  important foundation to collaborative practice,
  particularly in a rural setting.

• Must have the right skill set/provider mix,
  necessary funding, and the required
  communications and technology.

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Moving Forward

• An RHA must raise this issue with health care
  professionals to determine if liability and scope
  of practice are serious concerns to expanding
  collaborative care further.

• Must continue to address liability concerns that
  may still exist.

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Moving Forward

• Must provide for ongoing evaluation of
  integration of NP role in a rural practice
  setting.

• IRHA has an opportunity to document and provide
  ongoing evaluation on what works in ensuring
  effective use of NPs within a rural setting.

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Questions and Comments?