Integrating nurse practitioners into primary care: policy considerations from a Canadian province
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RESEARCH ARTICLE
Open Access
Integrating nurse practitioners into primary care: policy considerations from a Canadian province Stacey Black* , Raad Fadaak and Myles Leslie
Abstract Background: The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods: Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results: Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions: In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals. Keywords: Nurse practitioners, Primary care, Policy, Funding, Role, Integration, Collaboration
Background The integration of nurse practitioners (NPs) into primary care has been viewed as a solution to shortages of doctors [1], and a tool for improving patient access to care and lowering costs [2]. It has also been suggested that the integration of NPs into communitybased care delivery is critical to accomplishing the transformation of primary care into primary health care (PHC) [3, 4] - a transformation that has itself been linked to improved care, improved outcomes,
* Correspondence: [email protected] The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
and lowered costs [5–8]. The shift to PHC is one towards prevention, health, wellness and the successful management of chronic disease [9–14], accomplished through team-based care [15]. The integration of NPs into PHC-focused teams, and their integration into healthcare systems more broadly has been advocated for in a range of policy environments, including both Canada and the United States [16–19]. Despite this alignment
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