BackgroundAn important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice.MethodsA sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis.ResultsFour major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses.ConclusionsConsumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting.
An important consideration in health service delivery is ensuring that services meet consumer needs. Whilst nursing services in primary care have grown internationally, there has been limited exploration of consumer satisfaction with these services. This paper reports a descriptive survey that sought to evaluate consumers' perceptions of New Zealand practice nurses (PNs). One thousand, five hundred and five patients who received nursing services at one of 20 participating New Zealand general practices completed a survey tool between December 2010 and December 2011. The 64-item self-report survey tool contained the 21-item General Practice Nurse Satisfaction (GPNS) scale. Data were analysed using both descriptive and inferential statistics. Internal consistency of the GPNS scale was high (Cronbach's α 0.97). Participants aged over 60 years and those of European descent were significantly less satisfied with the PN (P = 0.001). Controlling for these characteristics, participants who had visited the PN more than four times previously were 1.34 times (adjusted odds ratio 1.34 (95% CI: 1.06-1.70) more satisfied than the comparison group (up to 4 previous visits to PN). In addition to the further validation of the psychometric properties of the GPNS scale in a different setting, the study also revealed a high level of satisfaction with PNs, with increased satisfaction with an increased number of visits. Nevertheless, the lower levels of satisfaction with PNs in the older age group as well as those of European descent, warrants further examination. The study also highlights the need for PNs and consumers to discuss consumer's expectations of services and create a shared understanding of treatment goals. Controlling for these characteristics, participants who had visited the PN more than four times previously were 1.34 times (adjusted odds ratio 1.34 (95% CI: 1.06 to 1.70) more satisfied than the comparison group (up to 4 previous visits to PN). In addition to the further validation of the psychometric properties of the GPNS scale in a different study setting, the study also revealed a high level of satisfaction with PNs, with increased satisfaction with an increased number of visits. Nevertheless, the lower levels of satisfaction with PNs in the older age group, as well as those of European descent warrants further examination. The study also highlights the need for practice nurses and consumers to discuss consumer's expectations of services and create a shared understanding of treatment goals. 3 What is known about the topic?Nursing in primary care is conceptually alluring to enhance service delivery and increase the range of services available in primary care. Consumer satisfaction is linked to improved compliance with therapeutic regimes and improved health outcomes. There has been limited evaluation of consumer satisfaction with nursing services in general practice. What does this paper add?This paper quantifies consumer satisfaction with general practice nurses, providing evidence for the acceptability of ...
Primary Health Networks (PHNs) are tasked to enhance the efficiency and effectiveness of general practice. Gold Coast Primary Health Network (GCPHN) has been collecting de-identified aggregated clinical data from general practices and reporting back on areas for improvement on data coding and some clinical metrics, such as blood pressure not being recorded. However, aggregated data cannot be used to intervene at the individual patient level, and because of the collection-to-reporting time-lag, the data cannot help facilitate immediate action in the general practice. GCPHN developed a practice-based population health management approach based on mapping data from general practices to international coding classification systems, and applying evidenced-based algorithms and tools. General practices are provided with a health profile of their entire patient population, from the healthiest to the most complex comorbid patients. The information is conveyed as alerts and reports on areas including medication quality and safety, possible gaps in care and high-risk patients. The information is received based on the practice's preferences; this can be at the time of data entry, the following day or as specified. Strong clinical governance has ensured GCPHN's approach and methodologies are evidenced-based and appropriate. The consistent application of clinical governance within general practices is also needed to ensure the approach is sustainable and improves clinical outcomes.
Primary Sense is a new data extraction, analysis and reporting tool that the Gold Coast Primary Health Network (GCPHN) has developed to enable practical and effective population health management in general practice and also on a regional level. Once installed, the tool de-identifies data within the practice before running it through various clinical risk algorithms to create practical information that can easily be actioned within the general practice business model in at least two ways. The first is to generate up-to-date reports of patients who are most likely to benefit from specific interventions or occasions of service. The second is to identify potentially serious medication safety issues, alerting clinicians in real time at point of prescribing. Formal live testing of the system was completed in nine practices where 22 managers and nurses and 42 GPs used the tool over a 5-month period in 2019. The live test monitored the use of reports and alerts, and regular feedback from users enabled small but important improvements to the tool. Practice teams successfully used the reports to target specific groups of patients with outstanding care needs or who were at greatest risk of adverse health outcomes. The results of the live test showed that users found Primary Sense to be easy to use and beneficial to general practice. The next phase of this project is now underway to further trial the scalability and change management requirements for full implementation of Primary Sense. As more and more practices adopt the tool, the aggregated data will increasingly help to support population health planning, commissioning of local services, active health surveillance and other related activities.
This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.
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