A Multiple-Case Study in Nurse Practitioner-Led Clinics: An Exploration of the Quality of Care for Patients with Multimorbidity.

The previous 16 years have seen a number of healthcare reforms meant to increase access to primary healthcare services in Ontario. This included the establishment of an innovative model, the nurse practitioner-led clinics (NPLCs). NPLCs held promise for nurse practitioners (NPs) to practice to their full potential and optimize patient care. A multiple-case study was undertaken to evaluate the quality of care for patients with diabetes and multimorbidity at NPLCs. Five NPLCs, all in underserved areas in the mid-northern region of the province, were part of the study. Data collection included a chart audit, NP interviews and review of organizational information. Multiple-case analysis was conducted and four interrelated themes emerged about the quality of care of patients with diabetes and multimorbidity at the NPLCs. It was confirmed that the NP is the primary care provider at NPLCs. Healthcare policy such as a lack of increase in NP salary for 10 years has contributed to poor NP recruitment and retention. Insufficient healthcare resources in the communities where NPLCs are located and high patient vulnerability have a negative influence on the quality of care. Strategies, including mentoring, offer possible solutions to improve the quality of care at NPLCs.