rimary health care reforms in many countries include paying attention to increasing access to health care. One approach to improving access in Canada is integration of nurse practitioners (NPs) into primary care, particularly in rural settings, where NPs are more likely to work in the community rather than in a hospital. 1 This study focuses on the practices of NPs working in northern British Columbia, where factors influencing integration of NP roles can include the combination of changing patterns in the family physician workforce, 2 increasing patient medical and social complexity 3,4 and uptake of the message by decisionmakers that "NPs increase access to care." 5 Nurse practitioners have been regulated primary care providers in British Columbia since 2005.Access to health care is dependent on interrelated dimensions of the health system and abilities of patients, 6 and although evidence supports that NPs do increase access to care, 7,8 few studies have evaluated how this is accomplished. [6][7][8][9][10] As advanced practice nurses, NPs have competencies that extend beyond direct patient care to encompass proficiencies related to research, education and leadership. 11 Therefore, NPs are poised to contribute to a shift toward delivery of comprehensive, interprofessional, community-based primary health care, 12,13 and away from selective or niche models of primary care that may not address patient or community needs in a thorough manner. 7,14 The message that NPs increase access is consistently offered as a rationale for NP role creation, [15][16][17] but there may be more nuanced aspects of NP practice that can be explicated to support further successful integration of NP roles and strengthen the primary health care system.The aim of this study was to evaluate how NPs are engaged in primary health care practices in the context of their work settings as salaried health authority employees who are part of interprofessional primary care teams in northern BC primary care clinics. Methods DesignThe study was a qualitative-dominant mixed-methods study, 18 using a survey and interviews. The study team included 3 members whose roles encompass research and clinical work
Corticosteroid (steroid) medications are associated with challenging adverse effects that can negatively impact patient quality of life. However, owing to a long legacy of effective use in treatment protocols, they remain a cornerstone of multiple myeloma (MM) care. We conducted a roundtable with Canadian healthcare providers (HCPs) with diverse healthcare backgrounds and involvement in MM care as well as with patients with MM. Our goal was to develop clear guidance for steroid management aimed at improving patient quality of life, taking into account patient perspective and experiences with managing the disease. Our recommendations, which are based on the insights acquired from this discussion, can be categorized to the following areas: steroid prescribing, dosing, and modifications; managing adverse effects; and patient-HCP communication. These recommendations can be used by the entire multi-disciplinary hematology team to improve patient quality of life while being treated with steroid medication for multiple myeloma.
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