School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada.
School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada.
Health Policy. 2017 Dec;121(12):1215-1224. doi: 10.1016/j.healthpol.2017.09.019. Epub 2017 Oct 5.
Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients' experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams.
护士，无论是注册护士 (RNs) 还是执业护士 (NPs)，都正在成为初级保健服务的主要提供者。虽然越来越多的证据表明执业护士对初级保健患者体验的影响，但注册护士的情况则不然。我们使用 2013/14 年国际初级保健质量和成本研究的加拿大部分来调查护士如何影响初级保健患者体验的机制，重点关注护理的可及性和适当性。这些数据使我们能够区分家庭执业护士、专门护士和执业护士，并涵盖在各种情况下访问初级保健诊所的所有类型的患者。除了护士的类型和全职等效人数外，我们还探讨了护士自主权和协作的作用。我们的回归结果表明，患者体验最重要的预测因素之一是卫生专业人员之间的协作，而全职等效人数的护士人员配备本身影响不大。不同类型的护士会影响可及性的不同方面，而患者体验与护士人员配备之间的关联取决于诊所的医生人数。我们的研究结果可以为决策者提供信息，了解如何加强初级保健服务，特别是在加拿大背景下，适应最近实施的多专业初级保健团队。
