Health Care Provision in a Swiss Urban Walk-In-Clinic. Is Advanced Nursing Practice a Solution for a New Model in Primary Care? / Gesundheitsversorgung in einer städtischen Walk-In-Praxis in der Schweiz. Ist Advanced Nursing Practice ein neues Modell in der Grundversorgung?

Abstract

Background: Changing demographic and economic factors are producing serious challenges to Switzerland's primary care providers: meeting the population's growing needs will require redevelopment and reorganization. Large-scale community-based care can be expanded via alternative care models, including walk-in-clinics (WIC) stuffed by interdisciplinary teams, with Advanced Practice Nurses (APNs) playing key roles in the treatment of minor complaints. Aims: To reveal the proportion of adult patients within five exemplary diagnostic groups (respiratory tract infections, earaches, hearing impairments, urinary tract infections and wounds) who could be treated by APNs in a Swiss urban WIC in order to develop a future model of multidisciplinary collaboration between APN and physicians. Methods: A retrospective data analysis was performed on WIC's medical records. Reflecting seasonal variations, a one-month patient data sample was collected for each of four consecutive seasons (. Data analyses included calculations of frequencies of individual diagnoses and of diagnostic groups. Results: Of a combined sample of 5,130 patient consultations, 53% (n=2,733) fit within the scope of APN competencies. The most common diagnoses concerned minor wounds (24%; n=1,240) and upper respiratory tract infections (18%; n=926). Conclusion: Based on this study's results, we conclude that assigning APNs to primary care clinics would contribute a meaningful new professional role to Switzerlands healthcare system. Further research will be necessary to evaluate the effects of such implementation on inter-professional collaboration and patient outcomes.Hintergrund: Durch demographische und wirtschaftliche Faktoren sowie durch die Entwicklung der medizinischen Versorgung verändern sich die Ansprüche an das Gesundheitswesen. Ausbau und Umstrukturierung der Primärversorgung werden zwingend notwendig, um der veränderten Nachfrage gerecht zu werden. Insbesondere die gemeindenahe Versorgung für eine breite Bevölkerungsschicht kann mit alternativen Versorgungsmodellen ausgebaut werden. Ein entsprechendes Modell sind Walk-In-Praxen (WIP) mit interdisziplinären Versorgungsteams. In diesen nehmen Advaced Practice Nurses (APN) bei der Patientenversorgung eine zentrale Funktion ein. Zielsetzung: Das Ziel der vorliegenden Studie war, den Anteil erwachsener Patienten zu erheben, die anhand fünf exemplarisch gewählten Diagnosegruppen (Atemwegsinfektionen, Ohrschmerzen, Hörminderungen, Harnwegsinfektionen und Wunden) in einer städtischen WIP in der Schweiz durch APNs versorgt werden könnten, um darauf künftig eine multidisziplinäre Zusammenarbeit von APNs und Ärzten aufbauen zu können. Methoden: Eine sekundäre, deskriptive Datenanalyse bestehender Krankengeschichten einer städtischen WIP wurde durchgeführt. Ergebnisse: Erfasst wurden alle Konsultationen von vier untersuchten Monaten (N = 12'496), wovon 5'130 Konsultationen in die Analyse eingeschlossen werden konnten. Davon lagen 53% (n = 2'733) im Kompetenzbereich der APNs. Den grössten Anteil bildeten die Kons...

Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study

“…Studies about APNs in Switzerland are sparse, particularly regarding their role in primary care [2]. Kambli et al [23] estimated that 53% of patient consultations in a Swiss urban walk-in clinic could potentially be taken over by APNs and concluded that the APN role would contribute meaningfully to the Swiss health care system. Another study by Steinbrüchel et al [24] examined the views of GPs on potential models of collaboration between doctors and nurses.…”

How time consuming are general practitioners’ home visits? Insights from a cross-sectional study in Switzerland

“…The forthcoming shortage of GPs and the aging population in Switzerland will most certainly increase GPs' time burden and negatively affect home visits in the future. Increasing the number of GPs through improved training, better work-life balance and higher financial attractiveness [34][35][36], as well as delegation of home visits to advanced practice nurses [37,38] or private home healthcare agencies [39] are possible options to face the upcoming challenges in primary care in Switzerland.…”