プライマリケアの質 オープンアクセス

抽象的な

The value of nurse practitioners in Dutch general practices

Angelique TM Dierick-van Daele, Cor Spreeuwenberg, Emmy WCC Derckx, Yvonne van Leeuwen, Thea Toemen, Marja Legius, Joyce JM Janssen, Job FM Metsemakers, Hubertus JM Vrijhoef

BackgroundHealthcare systems are faced with a changing and increasing demand for care. Against the background of the need to increase service capacity and to improve access to primary care, a project was initiated to introduce the nurse practitioner (NP) role into Dutch general practices. ObjectiveTo explore the value of the NP by describing NP roles and their concordance with the initial concepts of the NP training programme. MethodsAn observational longitudinal design, using mixedmethods, was conducted betweenMarch 2004 and June 2008. A convenience sample of seven NPs and seven teaching general practitioners (GPs), together constituting seven experimental groups, was used. Project documentation and data from consultations between NPs and GPs were collected. Twenty-nine interviews were performed, focusing on NP roles, competencies of NPs and collaboration between professionals. ResultsAs was anticipated, all NPs have patients with common complaints as their main focus, as well as managing the quality of care projects. Differences between NPs are reported in the percentages of time spent in performing home visits, caring for older people, patient related activities and nonpatient related activities. ConclusionNPs contribute to the accessibility and availability of primary care as well as to collaboration in and quality of primary care. The roles they adopt are influenced by practice needs and financial incentives. It is not clear to what degree NPs have to perform activities to improve quality of care and further research is necessary to define NP core competencies.