Desborough Jane, Bagheri Nasser, Banfield Michelle, Mills Jane, Phillips Christine, Korda Rosemary
Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
Int J Nurs Stud. 2016 Dec;64:108-119. doi: 10.1016/j.ijnurstu.2016.10.004. Epub 2016 Oct 17.
The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models.
Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care.
This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
2004年至2012年间，澳大利亚从事全科医疗护理工作的护士数量增长了两倍。然而，关于全科医疗护理能否改善患者治疗效果的证据却很匮乏。尽管患者满意度和赋能效果作为全科医生护理的结果已得到广泛研究，但对于全科医疗护理在这些结果方面的研究却很少。本研究的目的是探讨特定的全科医疗特征与护士诊疗特征之间的关系，以及患者满意度和赋能效果。
一项混合方法研究对澳大利亚首都地区21家全科诊所的患者进行了横断面调查。向在2013年9月至2014年3月期间接受护理的1665名患者发放了患者赋能与满意度调查问卷。采用扎根理论方法对来自这些诊所的工作人员和患者的访谈进行分析。使用多层混合效应模型对两个部分的数据进行综合分析。
分析了678份完整患者调查问卷的数据（回复率=42%）以及对16名护士、23名患者和9名诊所经理进行的48次访谈。与诊疗时间较短的患者相比，接受护士诊疗时间较长的患者更满意（比值比=2.50，95%置信区间：1.43 - 4.35）且赋能效果更好（比值比=2.55，95%置信区间：1.45 - 4.50）。与从未见过的护士诊疗相比，与同一名全科医疗护士保持连续护理的患者更满意（比值比=2.31，95%置信区间：1.33 - 4.00）。与在诊疗范围窄、自主权低的诊所接受护理的患者相比，在护士诊疗范围广、自主权高的诊所接受护理的患者更满意（比值比=1.76，95%置信区间：1.09 - 2.82）且赋能效果更好（比值比=2.56，95%置信区间：1.40 - 4.68）。接受慢性病管理护理的患者（比值比=2.64，95%置信区间：1.32 - 5.30）比接受预防性医疗保健的患者赋能效果更好。
本研究首次证明了全科医疗护士护理的连续性、全科医疗护士诊疗的充足时间、广泛的护理诊疗范围和自主权对于患者满意度和赋能效果的重要性。本研究结果证明了全科医疗中强化护理角色的真正价值。这些结果表明，当实施改善协调和多学科初级卫生保健的愿景，包括扩大护士的角色时，可以实现高质量的患者治疗效果。
