National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants

Abstract

ObjectiveTo evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making.DesignNationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups).MethodsSurveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015.ResultsQuantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled.ConclusionsInformal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.

Perceptions of interprofessional collaboration in education of dentists and dental hygienists and the impact on dental practice in the Netherlands: A qualitative study

“…Based on experiences with the substitution in the field of nurse practitioners and physician assistants (who are performing medical procedures traditionally carried out by doctors), we expect that, due to the more effective and efficient use of everyone's competences, this overlap will decrease. 18 Another major change in the intended collaboration is that dental hygienist and dentist will work alongside each other, instead of the more hierarchical collaboration of the past. This requires new interprofessional collaboration skills.…”

Experience of the Irish physician associate role: PA and supervising consultant perspectives

“…To enable effective task-shifting, it is important that any future PA regulation corresponds to the highest level of the PA's training. [34] The PA role is still emerging in Ireland and is being driven by similar factors as in other countries across the world: a shortage of physicians and workforce capacity [13,28,33] as well as a need for task shifting. [34] Thus, PAs are increasingly described as part of the solution to workforce shortages.…”

“…[34] The PA role is still emerging in Ireland and is being driven by similar factors as in other countries across the world: a shortage of physicians and workforce capacity [13,28,33] as well as a need for task shifting. [34] Thus, PAs are increasingly described as part of the solution to workforce shortages. The conversation on how to best improve healthcare delivery in Ireland continues, with one approach being restructuring surgical teams and exploring the expansion of roles such as the PA. [35,36] The Irish PA has the potential to expand to other settings and has been suggested for use in primary care, [37] which has been described in Ireland as under-sourced and as a crisis situation in the media.…”

Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

“…This could be explained by the fact that NPs do not have independent, full prescription rights in Switzerland yet, and educational programs still lack several hours on pharmacology compared to international standards, which could yield in hesitation of prescribing new drugs. De Bruijn-Geraets et al (39) found that prescription rates of Dutch NPs increased after obtaining full legal practice authority. However, during out-of-hours consultations, Van Der Biezen et al (30) found that NPs still prescribed less medications compared to GPs.…”