Interprofessional Teams: Lessons Learned From a Nurse-Led Clinic

Evaluation of Nurse-Led and Student-Led Community-Based Clinics: A Scoping Review

AIM

To synthesize approaches used to evaluate nurse-led clinics (NLCs) and student-led clinics (SLCs) delivering community-based primary healthcare.

DESIGN

A scoping review based on Joanna Briggs Institute (JBI) guidelines.

METHODS

This review included articles evaluating the impact of NLCs and SLCs, published between 2013 and 2023. The Quadruple Aim Framework for health systems quality improvement was a reference point for thematic analysis.

DATA SOURCES

CINAHL Complete, ProQuest Nursing & Allied Health, PubMed, Scopus, Health Systems Evidence, Ovid Emcare and grey literature repositories were searched in March-June 2023.

RESULTS

Our search yielded a total of 891 articles and 43 articles were included in this scoping review. Diverse quantitative and qualitative methods and concepts of interest were evident in the evaluations of NLCs (n = 15), medical SLCs (n = 15) and interprofessional SLCs (n = 13). Extracted data spoke to the evaluation of either client experience, health of communities, systems of care delivery or provider experience, with systems of care delivery being the most consistently evaluated domain across all clinic types.

CONCLUSION

Traditional and non-traditional evaluation measures spanning the Quadruple Aim Framework were used to study community-based NLCs and SLCs. Opportunities remain for broadening the range of indicators and methods used to capture clinic impact on health equity.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Numerous transferable research approaches are available to students and clinical professionals for supporting the design and iterative improvement of innovative primary healthcare clinics.

IMPACT

The results highlight ways in which NLCs and SLCs may be evaluated for their concurrent impact on healthcare service delivery and clinical education systems.

REPORTING METHOD

PRISMA-ScR.

PATIENT OR PUBLIC CONTRIBUTION

Feedback amassed during presentations to nursing audiences informed the enclosed discussion points.

TRIAL REGISTRATION

Review protocol was published with the Open Science Framework under ID 10.17605/OSF.IO/FP6S4.

Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery

OBJECTIVES

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery.

METHODS

This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates.

RESULTS

Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02-0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients.

CONCLUSIONS

Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.

Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BACKGROUND

The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings.

PURPOSE

The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders.

METHODS

Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included.

FINDINGS

Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms.

DISCUSSION

More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.