Borgès Da Silva Roxane, Brault Isabelle, Pineault Raynald, Chouinard Maud-Christine, Prud'homme Alexandre, D'Amour Danielle
1 University of Montreal Public Health Research Insitute, Montreal, Quebec, Canada.
2 Faculty of Nursing of University of Montreal, Montreal, Quebec, Canada.
J Prim Care Community Health. 2018 Jan-Dec;9:2150131917747186. doi: 10.1177/2150131917747186.
Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better.
Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups.
Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher.
Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.
护士被视为初级保健中患者管理的关键提供者。本研究的目的是评估患者在初级保健中与护理角色相关的护理体验。其目的是检验以下假设：在患者由护士进行系统随访、护理能力因此得到最佳利用的初级卫生保健组织（PHCOs）中，患者的护理体验更好。
基于结合组织调查和护理体验调查的横断面分析，我们构建了两组初级卫生保健组织。第一组初级卫生保健组织报告有一名护士系统地随访患者。第二组有一名护士开展各种活动，但不系统地随访患者。基于患者问卷构建了五个护理指标。使用具有随机截距且患者嵌套其中的双变量和多变量线性混合模型来分析两组中的护理体验指标。
双变量分析显示，与护士开展其他活动的初级卫生保健组织相比，有护士系统随访患者的初级卫生保健组织中患者的护理体验更好。在纳入与初级卫生保健组织和患者相关的调整变量的多变量分析中，发现可及性指标更高。
结果表明，护士对患者进行系统随访在可及性方面改善了患者的护理体验。充分发挥护士的执业范围是提升患者护理体验和卫生服务效率的一个有前景的途径。
