PDF(Pubmed)
Abstract：
BACKGROUND: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.
METHODS: We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.
RESULTS: Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients\' health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it- \"a grey area.\" Establishing and maintaining a longitudinal relationship that responded holistically to patients\' needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients\' needs. Participants indicated NPs tried to address all of a patient\'s concerns at each visit.
CONCLUSIONS: Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.
METHODS: We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.
RESULTS: Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients\' health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it- \"a grey area.\" Establishing and maintaining a longitudinal relationship that responded holistically to patients\' needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients\' needs. Participants indicated NPs tried to address all of a patient\'s concerns at each visit.
CONCLUSIONS: Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.
摘要：
背景：缺乏获得医疗保健的机会是全球性的公共卫生危机。在初级保健中，它导致了护士从业人员的实施增加，并提高了对患者小组能力的兴趣。这项研究的目的是检查影响安大略省基于团队的初级保健中护士从业者患者小组规模的因素，加拿大。
方法：我们使用了多案例研究设计。有目的地选择了包括农村和城市环境在内的八种基于团队的初级保健实践作为案例。每个病例都有两个或两个以上的执业护士，至少有两年的初级保健经验。面试是亲自进行的，录制的音频，使用内容分析进行转录和分析。
结果：40名参与者，包括19名护士，16名管理员(包括高管，经理,和接待员)，5名医生接受了采访。病人,提供者,组织，和系统因素影响护士执业患者小组的大小。有八个子因素：患者健康和社会需求的复杂性；整体护理模式；护士执业经验和信心；多学科团队的组成和运作；文书和行政支持，以及护士执业活动和期望。所有参与者发现很难确定护士从业者的小组大小，称之为“灰色地带”。“建立和维持一种纵向关系，从整体上回应患者的需求，是护士从业者如何提供护理的基础。社会因素如性别、贫穷,心理健康问题，历史创伤,边缘化和识字导致了患者需求的复杂性。参与者表示，NPs试图在每次就诊时解决患者的所有问题。
结论：护士从业者有一个全面的方法，包括关注健康的社会决定因素以及急性和慢性合并症。这种方法迫使他们尝试解决患者在每次就诊时经历的所有需求，并减少他们的面板大小。多学科团队在跨提供者构建服务时，有机会深思熟虑，以满足更多患者的健康和社会需求。这可以使得护士从业者小组的大小能够增加。
方法：我们使用了多案例研究设计。有目的地选择了包括农村和城市环境在内的八种基于团队的初级保健实践作为案例。每个病例都有两个或两个以上的执业护士，至少有两年的初级保健经验。面试是亲自进行的，录制的音频，使用内容分析进行转录和分析。
结果：40名参与者，包括19名护士，16名管理员(包括高管，经理,和接待员)，5名医生接受了采访。病人,提供者,组织，和系统因素影响护士执业患者小组的大小。有八个子因素：患者健康和社会需求的复杂性；整体护理模式；护士执业经验和信心；多学科团队的组成和运作；文书和行政支持，以及护士执业活动和期望。所有参与者发现很难确定护士从业者的小组大小，称之为“灰色地带”。“建立和维持一种纵向关系，从整体上回应患者的需求，是护士从业者如何提供护理的基础。社会因素如性别、贫穷,心理健康问题，历史创伤,边缘化和识字导致了患者需求的复杂性。参与者表示，NPs试图在每次就诊时解决患者的所有问题。
结论：护士从业者有一个全面的方法，包括关注健康的社会决定因素以及急性和慢性合并症。这种方法迫使他们尝试解决患者在每次就诊时经历的所有需求，并减少他们的面板大小。多学科团队在跨提供者构建服务时，有机会深思熟虑，以满足更多患者的健康和社会需求。这可以使得护士从业者小组的大小能够增加。
