Interprofessional Collaborative Teams

Interprofessional Collaborative Teams

chsrf.ca

Commissioned Paper by Canadian Nurses Association

Canadian Health Services Research Foundation

June 2012

Tazim Virani

Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation

This document is available at www.chsrf.ca.

This research report, commissioned by the Canadian Nurses Association, is a publication of the Canadian Health Services Research Foundation. Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit organization that is dedicated to accelerating healthcare improvement and transformation for Canadians. The views expressed herein are those of the authors and do not necessarily represent the views of CHSRF, CNA, or the Government of Canada.

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Interprofessional Collaborative Teams © 2012, Canadian Health Services Research Foundation.

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interProFeSSional CollaBorative teaMS

Table of conTenTsKEY MEssagEs ..................................................................................................................2

ExEcutivE suMMarY ..................................................................................................3

1 INTROduCTION ............................................................................................................6

2 PARAmETERS OF THE SCOPING REvIEw ...........................................................72.1 Objectives ................................................................................................................72.2 Questions Guiding the Scoping Review ................................................................7

3 mETHOdS .........................................................................................................................83.1 Overview .................................................................................................................83.2 Identifying Information Sources to Include in the Review ..................................83.3 Search Strategy and Information Extraction .......................................................83.4 Criteria for Case Studies ........................................................................................93.5 Limitations ..............................................................................................................9

4 RESulTS OF THE REvIEw ........................................................................................104.1 Overview ...............................................................................................................104.2 Interprofessional Team Model .............................................................................114.3 Nurse-Led Model ..................................................................................................124.4 Case Management Model ....................................................................................144.5 Patient Navigation Model ....................................................................................144.6 Shared Care Model ...............................................................................................16

5 BARRIERS ANd ENABlERS FOR SuCCESSFul APPlICATION OF mOdElS ....................................................................................................................17

6 RECOmmENdATIONS ...............................................................................................18

7 CONCluSION ................................................................................................................19

8 REFERENCES ..................................................................................................................20

APPENdICES ..........................................................................................................................24Appendix A: Search Terms and Strategy ......................................................................24Appendix B: Literature Summary Table ......................................................................26Appendix C: Case Study – Interprofessional Model of Care .....................................101Appendix D: Case Study – Interprofessional Model of Care ....................................105Appendix E: Case Study – Nurse-Led Model of Care ...............................................110Appendix F: Case Study – Patient Navigation Model of Care .................................115Appendix G: Case Study – Shared Care Model .........................................................119Appendix H: Factors Influencing Application of Models of Care in Primary Care ...........................................................................................................123Appendix I: Bibliography ............................................................................................127

2 Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation

KeY MessaGes ◥ Contrary to popular belief, there is an array of interprofessional collaborative care models in

primary care with an essential role for nurses. many of these models are found in Canada and also internationally.

◥ Five types of interprofessional care models with a substantive role for nurses were found in the published and grey literature:

◥ Interprofessional team models ◥ Nurse-led models ◥ Case management models ◥ Patient navigation models ◥ Shared care models

◥ One or more models of care can be implemented within the same healthcare setting. ◥ Evidence to support the effectiveness of these models of care varies, but there are increasingly

positive patient, provider and system level outcomes. ◥ Choosing the right model is dependent on the context. The context variables include:

◥ leadership (particularly nursing leadership), advocacy and championing of specific model ◥ Political environment, biases and supports ◥ Regulatory environment ◥ Knowledge about the needs of the specific population being targeted ◥ Availability, preparation and experience of human resources ◥ willingness of providers to collaborate ◥ Capacity to train the appropriate mix of providers ◥ Supports for team development (opportunities or forums, time, funding ◥ Supports to address the challenges and gaps in the healthcare system ◥ Available assets (balance in workload, funding, expertise, space, in-kind supports).

◥ lessons learned about planning and implementing interprofessional service delivery models of care need to be disseminated broadly along with supports for implementation.

◥ more research is required to identify the essential components of each of the five models; however, since context matters, implementation of innovative models of care should be encouraged, accompanied by rigorous evaluation.

interProFeSSional CollaBorative teaMS 3

eXecUTIVe sUMMaRYAs Canada strategizes on how best to provide equitable access to healthcare to its citizens, careful attention is being placed on how to optimize its health human resources in the most cost-effective manner. Increasingly, the response to this interest is to leverage and optimize the largest group of healthcare providers – nurses – while acknowledging that healthcare recipients require a range of knowledge and skills from a wide array of health professionals.

what examples of interprofessional collaborative models of care have been tested in primary healthcare? A scoping literature review was conducted that included published and grey literature as well as information gathered from key informants. The objectives of the review were (1) to gather examples of models of care in primary care and other non-acute care settings that included a substantive role for nurses, and (2) to understand the effectiveness of these models as well as the essential factors that influence their successful implementation.

The models of care identified from the review were loosely grouped in five broad categories:

1. Interprofessional team models2. Nurse-led models3. Case management models4. Patient navigation models5. Shared care models

Interprofessional team models are teams with different healthcare disciplines working together towards common goals to meet the needs of a patient population. Team members divide the work based on their scope of practice; they share information to support one another’s work and coordinate processes and interventions to provide a number of services and programs. In advanced or mature collaborative teams, the patient and family are included as key members of the team. Examples of interprofessional team models include family health teams, community health centre teams, and integrated health teams. Positive evidence of interprofessional team models is building, particularly for teams working with patients with chronic diseases and/or mental health needs.

Interprofessional team models of care vary based on the context, intra-group processes, nature of the tasks, and intensity of collaboration that are engineered in the structure and processes of the teams. The intensity of collaboration ranges from consultative activities to integrative work practices. The effectiveness of teams is dependent on the team members’ knowledge of one another’s roles and scopes of practice; mutual trust and respect amongst the team members; commitment in building relationships; willingness to cooperate and collaborate; and the extent to which the team has organizational supports. Incentives such as appropriate system-level policies/legislation, favourable compensation models, balance in workload, working arrangements (opportunities to communicate, discussion, conducting joint work) and team characteristics (team size, team leadership) influence how team members collaborate to achieve positive outcomes.

Nurse-led models of care are formal programs, centres, clinics or services that place primacy on the nurse’s role, and where the nurse independently and collaboratively provides nursing services. The nurse’s interventions are holistic in nature and include assessment, treatment, patient education, and health- and self-care supports, as well as outreach activities for hard-to-reach populations. Examples of nurse-led models include RN-led (led by registered nurses) or NP-led (led by nurse practitioners) clinics, nursing centres, or specific programs embedded in other broader programs or teams. Nurse-led programs can

Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation4

be generic, such as those that provide care for patients with undifferentiated problems, as in a primary care clinic, or they can be models designed for very specific patient groups or care needs (for example, cardiac patients, patients with rheumatoid arthritis, patients who require colorectal screening using flexible sigmoidoscopy or patients who need support with smoking cessation). Evidence shows that nurse-led models of care provide equal or better care when compared to physician-led models of care.

Case management models are most often embedded in multidisciplinary or interdisciplinary team models and tend to focus on complex or high-resource groups of patients such as patients with chronic conditions. The key feature is the assignment of a defined number of patients to one provider (a case manager) who takes the lead in coordinating the activities to meet patient goals, such as supporting the patients to remain in the community for as long as possible. The focus in this model tends to be on system-level factors such as preventing readmission or decreasing length of stay in hospitals. Nurses are often in the formal role of a case manager, as they bring a broad set of knowledge and skills (clinical, interpersonal and problem-solving). The evaluation of case management models has been difficult, as it is challenging to isolate the key elements that contribute to the outcomes. Research findings are mixed.

Patient navigation models are relatively new in the healthcare sector. They require a navigator who has a multifaceted role as a patient advocate, helping the patient navigate through the healthcare system by circumventing and/or removing barriers while coordinating activities to meet the patient’s needs. Navigators can be nurses, social workers or lay persons. Patient navigators tend to focus on the patient’s experience, ensuring the patient receives timely services as well as ensuring that he or she does not fall through the cracks in the healthcare system. Navigators who are nurses assess patients, address symptom management and “fast track” patients through the system, depending on clinical status. These models of care are being used with patients suspected as having, or who have been diagnosed with, cancer, as well as patients who have chronic diseases. The model has had mixed research findings.

Shared care models are primarily models in which two healthcare providers (for example, a nurse and a physician, nurse and pharmacist or nurse and community health worker) share or have joint responsibility for specific patient groups or programs. Other providers are involved, but to a significantly lesser degree. Sharing or co-management of patients or programs requires clear roles and responsibilities, high levels of communication and collaboration, and a high degree of trust and mutual respect for each other’s contribution to patient care. There are mixed findings on the impact of these models on health and system outcomes. Issues are primarily related to role ambiguity and trust between providers.

An extensive inventory of barriers and enablers was identified from the literature and from analysis of the case studies. These are grouped in five categories:

1. Policy/system factors (favourable legislation for optimizing scope of practice)2. Appropriate model of care factors (suitable to patient population needs)3. Individual/team factors (effective interprofessional collaboration)4. Organization factors (appropriate business case)5. Implementation factors (training, integrated work processes)


These factors have not been differentiated for the five models because there are significant commonalities in barriers and enablers across the models.

Five broad recommendations are made based on the lessons learned from this scoping review:

1. Study further the models of care identified in this scoping review. 2. Be open to the plurality of primary healthcare models, at least in the short run. Supporting diverse

models of care is a good thing.3. develop a pan-Canadian strategy to integrate registered nurses and nurse practitioners in primary

care models of care. 4. Promote the use of evidence-based implementation of models of care using the PEPPA

framework (Participatory, Evidence-based, Patient-focused Process, for guiding the development, implementation, and evaluation of advanced nursing practice.

5. Support nurses in their quest to implement innovative models of care in primary care.


1 InTRoDUcTIonNumerous calls have been made to continue to improve the healthcare system, not only in terms of access but also in terms of effectiveness, efficiency and value for money1,2,3. Optimizing utilization of health human resources has been a consistent theme over the last decade4. Increasingly, the response to this challenge is to leverage and optimize the largest provider of healthcare – nurses – and in doing so, leverage the apparent benefits of interprofessional collaborative teams5.

This paper aims to explore and explain the use of models of care delivery that optimally utilize the role of nurses in primary healthcare, community-based care and other non-acute care contexts such as chronic disease management, long-term care, continuing care, health promotion and disease prevention. Additionally, exemplar models of care, as case studies, are identified to highlight essential elements of effective service delivery models and strategies for successful application. ultimately, this paper aims to inform the Canadian Nurses Association’s efforts to address policy priorities for a renewed health accord in Canada.


2 PaRaMeTeRs of THe scoPInG ReVIeW2.1 obJecTIVesThe objectives of this paper were shaped by the directions provided by a working group of the Canadian Nurses Association. Specifically, the objectives of the paper were to:

1. Report on the findings of a scoping review of interprofessional teams that include registered nurses and/or nurse practitioners in the context of primary healthcare, community and other non-acute care settings.

2. Provide specific examples of interprofessional teams in Canada that have demonstrated success from multiple perspectives (for example, patient, practice and system levels; chronic care models).

3. Based on evidence and expert opinion, identify the essential elements or key attributes of an efficient model for interprofessional teams.

4. Provide a brief analysis of the barriers to fully integrating interprofessional models of care into the Canadian health system.

5. Identify key success factors for implementing interprofessional models of care that involve nurses and nurse practitioners.

2.2 QUesTIons GUIDInG THe scoPInG ReVIeWThe following questions guided the scoping review, based on the stated objectives:

a) what are the types of interprofessional collaboration models that have been tested or implemented in Canada and elsewhere?

b) what is the role of the nurse in these models of care?c) what are the essential elements or key attributes of an efficient model for interprofessional teams?d) what factors pose barriers to the successful application of the models of care?e) what are the factors that have made interprofessional models successful?


3.0 MeTHoDs3.1 oVeRVIeWThe following key methods were used to gather the information for this paper:

a) Review of the literature to explore the variety of interprofessional models of care involving nurses. b) Review of grey literature (unpublished reports and papers) describing models of care including

field evaluation studies.c) Review of CNA’s concurrent papers.d) Interviews with key informants to develop detailed case studies of models of primary healthcare

found in Canada.

3.2 IDenTIfYInG InfoRMaTIon soURces To InclUDe In THe ReVIeWA scoping review methodology was used, as this approach allows an examination of the extent, range and nature of research activity and other literature with some degree of flexibility with respect to the quality of the publications. The value of scoping reviews is that they allow a topic area to be explored with some liberty with respect to the quality of the existing literature, and serve as a foundation for more rigorous review6.

we used a modification of the five steps identified by Arksey and O’malley7 for a scoping review:

1. Identifying the research question(s).2. Identifying relevant systematic reviews, randomized controlled trials (RCTs), qualitative research

studies, evaluation papers, reports, and descriptive information on models of care found on government, professional association, research and policy institution websites.

3. Selecting papers to include in the review.4. Collating and summarizing the information in a summary table (our initial tables were detailed;

these were further summarized for this report).5. Reporting the results.

In addition, we contacted individuals who could provide greater detail on selected models of care so that we could write five case studies exemplifying the different models in Canada. we interviewed 10 key informants (KI) by phone and/or received information by e-mail on select case studies (case study 1, 2 KI; case study 2, 1 KI; case study 3, 5 KI; case study 4, 2 KI; case study 5, 1 KI). Key informants were recommended by nursing leaders in the field based on who could best articulate the development and implementation of the model of care. Additional reports and documents provided by the key informants were reviewed to validate and/or add detail and clarification for the written case studies.

3.3 seaRcH sTRaTeGY anD InfoRMaTIon eXTRacTIonThe following literature databases were used to search and access published literature: Cochrane database of Systematic Reviews, Pubmed, CINAHl, HealthSTAR and Health-Evidence.ca. In addition, web searches were conducted using Google, and hand searches were done using reference lists from key reports and articles, as well as suggestions made by key informants. Broad search terms were used, including interprofessional teams, healthcare teams, collaboration, and primary healthcare. Additionally, specific search terms were used, including family health teams, chronic management teams and nurse-led models. (See Appendix A for detailed search strategy and articles included in the review.) The following criteria were used to include articles in the review:


a) written in English or French. b) Published or disseminated on the website from 2001 to 2012 (papers were limited to those that

were part of the recent rounds of primary care reforms and of models that were still in use). c) Involved a substantial role of a registered nurse or nurse practitioner.d) Contained detailed information on the description of the model and how the model was implemented.e) Addressed discussion of barriers, implementation challenges and success factors or solutions.

All papers meeting the above criteria were included regardless of type or quality of paper.

Three junior research assistants (two were bilingual) extracted information from each paper. A senior research lead reviewed the extracted information and where there were questions, the report/paper was reviewed by the research lead. This process allowed for the inclusion of an extensive set of information sources. This iterative process provided the opportunity to group models of care as the literature was being reviewed, and to re-group several times as further information was gathered. One type of model that emerged, which was later combined with “interprofessional team,” was the “self-management” model. Self-management models were seen as nested models within the interprofessional team model and were not viewed as independent or distinct models. (See Appendix B for the literature tables organized by type of models that emerged from the literature.)

3.4 cRITeRIa foR case sTUDIesThe following criteria were used to identify five examples of models of care in primary healthcare and to develop the detailed case studies:

a) All case studies should be examples of models of care delivery currently in use in Canada.b) Case studies should be geographically distributed, but not necessarily one per province or territory.c) Each case study should reflect one of the main categories of models of care that have been

identified in the literature/website review.d) Case studies should represent different practice settings.e) Case studies should represent different patient/client populations.

3.5 lIMITaTIonsScoping reviews are meant to assess the broad scope or “lay of the land.” As such, this review examined a range of papers with a range of study designs and reports generated by various organizations. However, the review is by no means exhaustive. The depth of examination of each model was constrained by available time and resources. Caution needs to be taken in making firm conclusions on the value of one model over another, as that was not the intent, nor were we able to identify rigorous studies comparing the models. we have also taken liberty to categorize the papers using loose definitions of the five models of care that emerged in the review and that are discussed in this paper.


4 ResUlTs of THe ReVIeW4.1 oVeRVIeWThe world Health Organization defines a primary healthcare team as “a group of persons who share a common health goal and common objectives determined by community needs, to which the achievement of each member of the team contributes, in a co-ordinated manner, in accordance with his/her competence and skills and respecting the functions of others”8. The search for primary healthcare team models of care resulted in the identification of five broad categories of such models involving nurses. The categories are not meant to be a rigid taxonomy or classification, but rather, a loose organization of models that emerged from the review of the literature. Overview of the models are presented in Table 1 to highlight the overall distinctions of the models. discussion of each model category follows the table.

table 1: Service delivery Models of Care in Primary Care

Model Context intragroup processes Scope of Practice effectiveness*

INter-ProFeSSIoNAl teAmS

various healthcare disciplines working together towards common goals to meet the needs of a patient population

Team members co-located at centres or clinics

model design is highly context dependent (local needs target patient population, availability of human resources)

various designs of team collaboration that range from consultation to integrated practices

Physicians generally leaders of the teams

division of labour based on scopes of practice of team members

Positive FindingsSystematic Reviews: Adams et al, 2007; Barrett et al, 2007; Craven et al, 2006; Suter et al, 2010;

RCTs: Humbert et al, 2009;

Other Studies: lui et al, 2003; Schaeder et al., 2008; Russel et al, 2009;

mixed FindingsSystematic Reviews: Zwarenstein et al., 2009

No ImpactRCTs: lin et al, 2006

NurSe-led modelS

Formally structured with the focus on the nurse delivering holistic care

Often dependent on lack of access to physicians

Independent practice and collaboration with other healthcare providers

Nurse has central role in governance and leadership

Nurses working to full scope of practice

model is highly dependent on the nurse’s role *and capacity to take on expanded responsibilities

Positive FindingsSystematic Reviews: Cooper et al., 2006; Glynn et al, 2010: Horrocks et al., 2002; laurant et al., 2007, 2009; lewis et al., 2009; Schadewaldt & Schultz, 2011 (no difference compared to convention model;

RCTs: Chui et al., 2010; Given et al, 2010; Hebert et al, 2008; Raferty et al., 2005; Ryan et al., 2006; Smeulder et al, 2010; van Zuelien et al., 2011

mixed FindingsSystematic Reviews

No ImpactSystematic Reviews: Cruickshank et al, 2008;

RCTs: New et al, 2003


CASe mANAgemeNt

An assignment of a set number of complex care patients to the nurse and to coordinate their care. Focus is on meeting organizational objectives for efficiency

Complexity of patient care, (for example, chronic diseases)

model design is highly dependent on patient care requirements

Nurse plays central role in coordinating team member requirements for the patients in the caseload

model design is highly dependent on size of team and the complexities of coordinating care activities

Potential to work to full scope of practice if there is a manageable caseload

Positive Findings:Systematic Reviews: Schroeder et al., 2008; Berra et al., 2011; Norris et al., 2002

mixed FindingsOther Studies: Taylor et al., 2005

No ImpactOther Studies: vam der Sluis et al., 2008

ShAred CAre Co-location of two primary care providers

Highly collaborative requiring high trust and respect between team members.

model is highly dependent on how providers work out their shared arrangement

working to full scope of practice

Positive Findings:Systematic Reviews: Kelly et al (2011); Research Power In., 2011

Other Studies: Griffiths et al, 2007

mixed: Other Studies: Smith et al (2007); Eley et al (2008)

No Impact

* References listed in Appendix B.

4.2 InTeRPRofessIonal TeaM MoDelDescription of interprofessional team models Interprofessional team models are teams comprising various healthcare disciplines working together towards common goals to meet the needs of a patient population. Team members divide the work based on the team members’ education and experience9; they share information to support one another’s work and coordinate processes and interventions to provide a number of different services and programs to their target population. Generally, there is an explicit or underlying value for non-hierarchical decision-making10.

Such models of care vary based on the context, the intra-group processes, the nature of the tasks, and the intensity of collaboration that is engineered in the structure and process of the teams11. The intensity of collaboration ranges from consultative activities to integrative work practices12.

The effectiveness of interprofessional teams is dependent on a number of factors, including the team members’ knowledge of one another’s roles; the scope of practice; mutual trust and respect amongst the team members; commitment in building relationships; willingness to cooperate and collaborate;13-15 and the extent to which the team has organizational supports16. Incentives such as appropriate system-level policies/legislation17, favourable compensation models18, balance in workload19, working arrangements20 (for example, opportunities to communicate, have meaningful discussion, conduct joint work, and leverage information systems) and team characteristics,21 such as team leadership and shared purpose, influence how team members collaborate to achieve positive outcomes.


At a practical level, interprofessional teams are involved in the assessment and planning of care, making independent and joint decisions about approaches to care, and providing direct services individually or jointly with other team members to meet the needs of the patient22. The team members meet informally, formally and virtually, and use various structures and tools to meet, communicate, coordinate and monitor care23.

In advanced interprofessional teams, the patient and his or her significant others are central members of the team24, 25. Structures, processes and tools are established that empower the patient in optimal involvement (for example, the patient has access to his or her electronic health record). Patients and their caregivers are involved in regular team meetings, and patients are taught and supported to self-monitor and adjust their own treatment within given parameters.

Registered nurses, nurse practitioners, and in some instances licenced practical nurses are involved in generalist and/or specialized roles and often provide a pivotal role in a leadership, facilitative or a coordinating capacity. They also provide patient advocacy and direct service. more often than not, however, physicians play the leadership role in such models, particularly when the funding for primary care is tied with the physician reimbursement using fee-for-service or capitation models, in contrast to models where all team members are salaried26.

Examples of interprofessional team modelsThe literature has many examples of team-based collaborative models of care. The following are a few examples of these models and the context in which they are applied. (See Appendix C and d for two detailed case studies of interprofessional team model of care.)

a) Family Health Teams (FHT) in Ontario27

b) Community Health Centres (CHC) – found across all provinces in Canada, including the earliest ones in Quebec known as communauté locale de soins communautaires, or ClSCs28.

c) Integrated Health Teams – Katzie Integrated Health Team in British Columbia, led by the Katzie First Nation Health Promotion Team29; Sure Start local Programs (SSlPs in united Kingdom)30.

Effectiveness of interprofessional team modelsEvidence is building on the positive outcomes associated with interprofessional team- based primary care models. (See Table 1.) However, identifying the effectiveness of specific aspects of team structures and behaviours in the context of primary care requires more study31. Challenges that have been identified from qualitative studies include communication and relationships between members, documentation systems and practices, knowledge of team members’ scopes of practice, issues of team cohesion, referral mechanisms between team members, agreement of plans of care, and lack of a clear leader32.

4.3 nURse-leD MoDelDescription of nurse-led modelsThe emergence of nurse-led models of care is often associated with a chronic shortage of physicians and a lack of access to primary care. Nurse-led models of care are formally structured33 and the delivery of care gives primacy to the nurse’s role, where the nurse independently and collaboratively provides holistic care including assessment, planning, organizing, coordinating, care delivery/treatment, patient education and monitoring, and attention to social determinants of health. There are a number of features of nurse-led models that are different from conventional models34:


◥ They are independently managed by nurses while maintaining team-based collaboration. ◥ They are more holistic and are focused on prevention and education, in contrast to being

treatment- or medicinal-focused (although nurse-led models also do these). ◥ Beyond the conventional interventions, nurse-led models may include psychosocial support to

patients, outreach in the community, group-level activities and programs, coordination of activities, and a strong focus on health counselling, education and assisting patients with self-care management.

◥ Such models provide greater professional autonomy to nurses whereby nurses have their own patient case load. In some nurse-led models, nurses may make decisions related to patient admissions, referrals and discharge.

Examples of nurse-led models of careThere are a number of different nurse-led models of care delivery35 including RN (registered nurse)-led general models, RN-led specialist models, NP (nurse practitioner)-led general models, and NP-led specialist models. The decision on whether to have an RN or an NP is associated with the patient care needs and scope of practice of the nurse. (See Table 2 and see Appendix E for detailed case study.)

table 2: nurse-led Models of Care

Model examples

rN-led generalist models of Care delivery

Family practice clinics (Alsaffar, 2004)

Nurse-led primary healthcare walk-in centres (desborough et al, 2011). rN-led Specialist models of Care delivery

Nurse-led hepatitis C program (Butt, 2009)

Nurse-run post-acute stroke clinic (Crowe, 2009)

Nurse-led smoking cessation clinic (Thompson et al, 2007)

Nurse-led rheumatology clinic (Arvidsson et al. 2006)

Nurse-family partnership program (www.nurseamilypartnership.org)

RN-led flexible sigmoidoscopy clinics for colorectal cancer screening (dubrow et al, 2007).NP-led generalist models of Care delivery

NP-led clinics in Ontario (http://www.health.gov.on.ca/transformation/np_clinics/np_mn.html), NP-led school based primary healthcare clinic for children and families (Clendon, 2001)

NP-led multidisciplinary team to improve chronic illness (watts et al, 2009).NP-led Specialist models of Care delivery

NP-led anticoagulant clinic (Connor, 2002)

NP model of care for people with dementia (Ashcroft et al, 2010)

NP services for patients with chronic kidney disease (van Zulien et al, 2011).mixed rN, NP, generalist, and specialized

Comox valley Nursing Centre in British Columbia (www.viha.ca/comox_valley_nursing_centre).

Effectiveness of nurse-led modelsThere is good evidence to support nurse-led primary care models. (See Table 1 for details.) most research shows positive or similar outcomes to conventional care models. Having stakeholder buy-in and physician support are key factors of success.


4.4 case ManaGeMenT MoDelDescription of case management modelsCase management models are most often embedded in multidisciplinary or interdisciplinary models and tend to focus on highly complex or high-resource groups of patients such as patients with chronic conditions36. The key feature of this model is the assignment of a defined number of patients to one provider (a case manager) who takes the lead in collaborating with team members to develop a comprehensive care plan, coordinating the activities to meet patient goals, and monitoring the achievement of patient objectives and system-level targets37. The focus of the model is often on system-level factors such as preventing readmission or decreasing wait times. Nurses are often in the formal role of a case manager, as they bring a broad set of knowledge and skills in clinical, interpersonal and problem-solving domains and help to improve interprofessional collaboration38. In doing so, case managers are often “navigating” the system, advocating for the patient and identifying and addressing gaps in the healthcare system.

Case management is differentiated from patient navigation models in that the focus is on coordination of the healthcare team and other system players, and on creating efficiencies. The key processes in case management are case-finding, assessment, planning, action and monitoring39. The monitoring of cases is often over a longer period of time compared to other models.

Examples of case management modelsSchraeder et al.40 describe a collaborative primary care nurse case management model located in Illinois, u.S. that is situated within a multi-specialty physician group practice using a multi-disciplinary team model. The focus of case management is on patients with chronic conditions. Similarly, other case management models that focus on chronic disease management and/or complex care include:

◥ disease and care management41

◥ Guided care management42

◥ Supportive care clinic for cancer patients43

◥ Primary care case management for chronic care44

Case management models are widely used in the management and care of patients who are discharged from hospital to receive care in the home45.

Effectiveness of case management modelsSystematic reviews and studies of case management show a mixture of findings – some positive, some with mixed findings and some with no impact. (See Table 1.) It has been noted that it is difficult to isolate the impact of case management models, as they are often embedded or implemented with other models such as interprofessional team, nurse-led or patient navigation models46.

4.5 PaTIenT naVIGaTIon MoDelDescription of patient navigation modelsThe patient navigation model is a relatively newer model of care in the healthcare sector, requiring a patient navigator who has a multifaceted role. Navigators can be nurses, social workers or lay persons. The navigators are patient advocates who help the patient navigate through the healthcare system by circumventing and/or removing barriers while coordinating activities to meet the patient’s


needs47. Patient navigators tend to focus on the patient’s experience, ensuring the patient receives timely services and ensuring that he or she does not fall through the cracks in the healthcare system48. Navigators who are nurses assess patients, address symptom management and “fast track” patients through the system depending on clinical status. Hence, they also play a triage function49.

Patient navigation models, unlike case management models, do not focus largely on highly complex patient groups, nor are they all situated within a broader multi-disciplinary environment. However, various patient navigator roles include functions such as assessment, symptom management, patient education, and follow-up, which makes better use of the scope of practice of nurses50.

Although the notion of supporting the patient to navigate the healthcare system is not new, the formalized role of patient navigator is a recent innovation. The term patient navigation is purported to appear in the health literature around 199551 and is sometimes referred to as “nurse navigator” or used interchangeably with “care coordinator”52. The literature has examples of patient navigators who are nurses, social workers, community health workers or lay persons, and whose role overlaps with those of case managers53. Research on patient navigation for patients with cancer, particularly in the diagnostic/work-up stage, appears to be advanced compared to navigation for patients in cancer treatment or other health conditions54, 55.

The role of patient navigator aims to not only improve patient experience in the healthcare system, but also to decrease wait times for patient services; improve diagnostic resolution, timeliness in care and treatment adherence; improve the likelihood of follow-up; and improve clinical outcomes56. The approaches used by a patient navigator include assessing needs; developing relationships within the healthcare system in order to leverage this for the benefit of the patient; coordinating care aspects between healthcare providers and between providers and the patient/family; ensuring referrals do not fall through the cracks; reviewing diagnostic results and acting upon them in a timely manner; tracking wait times and timeliness to care; and identifying gaps in the system and thereby acting as a catalyst for change.

Gilbert et al.57 built a case for nurses to take the role of patient navigator in the cancer care sector. The authors note that nurses have the knowledge and skills to support patient care and work in an integrated manner with clinicians while improving the patient’s experience of the healthcare system.

Examples of patient navigation modelsAlthough it is a relatively recent model of care, a variety of patient navigation models are found in the literature. (See Appendix F for a detailed case study of one such model.) Other examples of patient navigation models include:

a) Patient navigator to support patients with confirmed breast lesion in Nova Scotia58.b) Navigation role for chronic care in older adults59.

Effectiveness of patient navigation modelsThere is some research to show the positive impact of patient navigation; however, the evidence is limited. (See details in Table 1.)


4.6 sHaReD caRe MoDelDescription of shared care modelShared care models are primarily models in which two healthcare providers (for example, a nurse and a physician, nurse and pharmacist, or nurse and community health worker) share or have joint responsibility for specific patient groups or programs. Other providers are involved but to a significantly lesser degree. Sharing or co-management of care requires clear roles and responsibilities, high levels of communication and collaboration, and a high degree of trust and mutual respect for each other’s contribution to patient care60.

This model is differentiated from the interprofessional team model in that shared care arrangements are established through formalized agreements and/or specific delineation of roles and responsibilities for the same group of patients, and are usually between two members. The healthcare providers may have independent practices or other groups of patients using different models of care while involved in co-management or shared care model for some of their patients61.

The focus of shared care models is most often on managing a higher roster or panel of patients in an effective and timely manner while providing high-quality and consistent care62. Additionally, there is an underlying belief that the combination of skills and knowledge brought together by the providers in the shared care arrangement provides a greater value-added service to the patients, thereby improving the quality of care63.

Although there are variations in shared care models, there are common features that have been noted64:

◥ Joint provision of clinical services by health providers, often located in the same setting. ◥ Shared responsibility for patient care by shared-care team members. ◥ Clear differentiation of roles among health providers, which is typically outlined in a shared-practice

guideline or memorandum of understanding. ◥ Collaborative education that seeks to increase understanding among shared-care team members

of each other’s professional skills, knowledge and abilities. ◥ development of a shared strategy for patient care that is based on explicated defined guidelines.

Examples of shared care modelsShared care models are often treated as interprofessional team models. However, as described above, this paper notes the key characteristics of the shared care model. (See Appendix G for detailed case study of one such model.) The following are examples of diverse shared care models:

a) Family Practice Nurse Initiative in Nova Scotia65

b) Nurse Practitioner/Family Physician Primary Care model in Interior British Columbia66 c) Nurse-led weekly clinic with general physician (GP) support occurring twice a year for patients

with poor diabetic control in the united Kingdom67 d) Nurse/pharmacy-led capecitabine clinic for colorectal cancer68

Effectiveness of shared care modelsThere is limited research evidence on the effectiveness of shared care models in primary care. One systematic review that was found focused on shared care arrangements between primary and specialist shared care arrangements69. Qualitative findings identify that issues with the models were primarily related to role ambiguity and trust between providers70. (See Table 1.)


5.0 baRRIeRs anD enableRs foR sUccessfUl aPPlIcaTIon of MoDelsAn extensive inventory of barriers and enablers was identified from the literature (see Appendix H) and from analysis of the case studies. These are grouped in five categories: policies/system; appropriate model of care; individual/team; organization; and implementation. These have not been differentiated for the five models discussed in this paper, as there are significant commonalities.

Policies or system factors address the conditions that enable models of care to take root and be effectively implemented. The lack of such enablers creates challenges in the optimal use of the full scope of nurses. These factors include legislation, regulation, funding support, data availability, research, educational requirements, fair compensation including benefits, and liability protection. Policies in almost all funding models generate tensions between policy controls and practice efficiencies: for example, patients must be seen by a physician in fee-for-service models regardless of whether the patient needs the physician; and adequate throughput of patients should be ensured in salary models. Policy decision-makers’ understanding and appreciation of these challenges and the impact of policy decisions appear to be ongoing challenges.

The appropriate model of care is highly context-dependent. Successful models reflect community needs and characteristics as well as priorities identified by community stakeholders. Flexibility in models is also important due to divergent needs of the community and the changing nature of these needs, requiring mechanisms to provide a varying intensity of programs and services. models of care are dependent on the availability of appropriate health provider resources and supports to work to full scope of practice. local adaptation of models of care, therefore, produces different models, each with its own set of challenges and successes. This creates difficulties in comparing the models’ effectiveness.

Individual and team factors play an obvious and intricate role in the successful application of any of the models of care discussed in this paper. The effectiveness of teams is dependent on how well individuals embrace working in teams, perceive advantages and disadvantages, have the competencies and experience to be effective team members, and have the right supports and tools. Having mutual trust and respect and knowledge of one another’s roles, the scope of practice, and how each member can bring value to patient care are cited frequently in the literature and by key informants.

organization factors refer to organizational supports and tools that enable the successful implementation and ongoing operation of models of care and effective and efficient interprofessional collaboration. Examples of these supports include a clear business plan, a governance mechanism, work place policies, and integrated processes. Insufficient supports and tools can lead to inappropriate conclusions on whether a model is successful or not.

Implementation factors can also support or hinder the successful outcomes of any of the models of care. Inadequate attention to supporting human resources, from selection to training and mentorship, can result in failed models. The use of evidence-based practices in providing programs and services are interlinked with models of care, as is the effective support for team development. These inter-related components – model of care, evidence- based practices and team collaboration – have to work in concert to result in positive patient, provider and system-level outcomes.


6 RecoMMenDaTIonsThe overall lessons derived in this paper are summarized in five key recommendations:

recommendation 1: Study further the models of care identified in this scoping review.

As with any scoping review, the findings are a broad reflection of the subject matter. Each of the five models of care identified in this paper (interprofessional teams, nurse-led, case management, patient navigation and shared care) requires a detailed literature review, conceptual clarification and more rigorous understanding of how the models are experienced in the field. The development of case studies in this paper is a first step towards this exploration.

recommendation 2: Be open to the plurality of primary healthcare models, at least in the short run. Supporting diverse models of care is a good thing.

Primary healthcare in Canada is undergoing reform and is experimenting with different models of care, team approaches and funding schemas, often within the same jurisdiction. The plurality of models will likely prevent the premature adherence to a single path of untested primary care model for the majority of the population.

recommendation 3: develop a pan-Canadian strategy to integrate registered nurses and nurse practitioners in primary care models of care.

Although models of care are context-dependent, there are a number of challenges that require stakeholders to come together to develop common solutions such as clarity in roles/scopes of practice, educational standards, supportive legislative frameworks, and public campaigns on the contribution nurses can make to primary care.

recommendation 4: Promote the use of evidence-based implementation of models of care using the PePPA framework (Participatory, evidence-based, Patient-focused Process, for guiding the development, implementation, and evaluation of advanced nursing practice [PePPA])71.

Extensive research has been done to develop and test the framework in the context of implementing advanced nursing practice roles in the field72. The framework takes into account the barriers and enablers identified in this paper and provides a systematic process and set of tools. It is therefore important to leverage this framework as well as other tools developed by the pioneers of the various models.

recommendation 5: Support nurses in their quest to implement innovative models of care in primary care.

various forms of support are needed for nurses in the field, including strong nursing leadership; communities of practice to share and learn and avoid isolation; and educational opportunities to continue strengthening knowledge, skills and confidence to meet increasing healthcare challenges and be effective collaborators working in teams.


7 conclUsIonThis paper aims to explore and explain the use of models of care delivery that enhance the role of nurses in primary healthcare and other non-acute care settings. The scoping review provides a preliminary focus of attention on five models of care: interprofessional teams, nurse-led models, case management, patient navigation, and shared care models. The case studies provide a detailed understanding of these models and greater insight into their emergence in the Canadian primary care system. An overview of factors that support or hinder the models of care has been outlined along with five broad recommendations.


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aPPenDIces aPPenDIX a: seaRcH TeRMs anD sTRaTeGYThe search terms were used in combination.

Population intervention Comparison outcomes

◥ Registered Nurses

◥ Nurse Practitioners

◥ Health Teams

◥ Practice teams

◥ Healthcare organizations

◥ Healthcare facilities

◥ Primary care

◥ Interprofessional teams

◥ Interprofessional collaboration

◥ Collaboration

◥ Teams

◥ Team based care

◥ Primary care

◥ Primary healthcare

◥ Family health teams

◥ Healthcare teams

◥ Chronic management teams

◥ Nurse-led

◥ Traditional teams

◥ Non team based

◥ Health services outcomes

◥ Right person at the right time to provide care

◥ Improve access to care

◥ Cost effectiveness, savings

◥ Team effectiveness outcomes

◥ Communication ◥ Coordination ◥ Collaboration ◥ Team member

satisfaction

◥ Patient outcomes – functional, disability, quality of life

◥ Population health status

◥ Optimized scope of practice

limitations: English, French, 2001 onwards, optimize role of NPs, RNs, primary care (health promotion, prevention, chronic management, screening, non-acute care/hospital care but include outpatient clinics and long term care/nursing homes)

databases: ◥ CINHAl, PuBmEd, Cochrane database ◥ Hand search references in key articles


literature/information retrieved

Sources Reviewed, Information Extracted in Data Table = 173

64 articles reviewed for general knowledge and to inform the

research team

Potential Articles/Sources on Models of Care

CINHAL Abstracts = 176

Pubmed Abstracts = 690

Cochrane Abstracts = 49

Website Hits - undefined

Screened and Included = 63

Screened andIncluded = 27




Hand Search/Other Abstracts = 76

Health Star and Healthevidence.ca searches did not produce additional papers of value.


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eitk

empe

r, m

.m.

(200

5). Th

e ro

les o

f nur

ses o

n In

terp

rofe

ssio

nal t

eam

s to

com

bat

elde

r mist

reat

men

t. N

urse

Out

look

, 53

, 253

-259

.

des

crip

tive

Stud

y

Role

s of n

urse

s on

the

IP te

ams o

n el

der

mist

reat

men

t

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Ger

iatr

ics

◥

Nur

ses o

n El

der m

anag

emen

t Te

ams a

id w

ith a

sses

smen

ts/

scre

enin

g, re

port

ing,

dire

ct c

are,

and

com

plai

nt in

vest

igat

ion

◥

Nur

ses o

n co

llabo

rativ

e Eld

er

man

agem

ent T

eam

s can

hel

p id

entif

y m

ore c

ases

of a

buse

sin

ce m

ost g

o un

repo

rted


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

4Ba

ker,

G.R

., & d

enis,

J.l.

(201

1).

A C

ompa

rativ

e St

udy

of Th

ree

Tran

sfor

mat

ive

Hea

lthca

re S

yste

ms:

Can

ada

Hea

lth l

esso

ns fo

r Can

ada.

Cana

da H

ealth

Ser

vice

s Res

earc

h Fo

unda

tion,

Otta

wa,

ON

, 1-4

0.

Avai

labl

e at

: ww

w.ch

srf.c

a.

Com

para

tive

Rese

arch

St

udy

Ove

rvie

w o

f 3 h

ealth

care

sy

stem

s, le

sson

s Can

ada

can

lear

n

CA

NA

dA

- G

ENER

Al

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e (m

odel

from

Ala

ska,

uta

h, a

nd S

wed

en)

◥

mod

els d

emon

stra

te v

ario

us

prin

cipl

es su

ch a

s pat

ient

driv

en

care

, tea

m-b

ased

car

e, pr

oact

ive

heal

th p

anel

s, an

d in

tegr

ated

be

havi

oura

l hea

lth

◥

mod

els h

ave

sh

own

impr

oved

pa

tient

eng

agem

ent

◥

For t

his m

odel

to w

ork,

ro

le e

xpan

sion

need

s to

occu

r; cr

eate

gre

ater

loca

l ca

paci

ty th

roug

h tr

aini

ng

and

lead

ersh

ip

◥Id

entif

y ke

y ta

rget

are

as fo

r im

prov

emen

t and

pri

oriti

ze

◥C

ontin

ue to

dev

elop

an

effec

tive

EmR

(Ele

ctro

nic

med

ical

Rec

ords

) sys

tem

5Ba

rret

t, J.,

Cur

ran,

v., G

lynn

, l., &

G

odw

in, m

. (20

07).

CH

SRF

Synt

hesis

: In

terp

rofe

ssio

nal C

olla

bora

tion

and

Qua

lity

Prim

ary

Hea

lthca

re.

Cana

dian

Hea

lth S

ervi

ces R

esea

rch

Foun

datio

n, 1

-54.

Syst

emat

ic R

evie

w

Expl

orin

g IP

mod

els

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

Prim

ary

Car

e

◥

Fam

ily p

hysic

ian

wor

king

in

vari

ous p

artn

ersh

ips w

ith n

urse

s, di

etiti

ans,

phar

mac

ists a

nd

com

mun

ity h

ealth

syst

ems

◥

3 ar

eas w

ere

revi

ewed

: IP

Col

labo

ratio

n an

d H

ealth

Sys

tem

O

utco

mes

, Pat

ient

Out

com

es,

Prov

ider

Out

com

es

Hea

lth S

yste

m O

utco

mes

: Bet

ter

coor

dina

tion

of ca

re, u

se o

f re

sour

ces,

broa

der r

ange

of s

ervi

ces

Patie

nt O

utco

mes

: Pos

itive

, bet

ter

acce

ss to

serv

ices

, im

prov

e wai

t tim

es, d

evel

oped

enha

nce s

elf-c

are

and

heal

th co

nditi

on k

now

ledg

e

Prov

ider

Out

com

es: P

ositi

ve,

heal

th w

orke

rs m

ore

satis

fied

wor

king

in a

n IP

env

ironm

ent


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

6Ba

xter

, P., &

mar

kle-

Reid

, m. (

2009

). A

n in

terp

rofe

ssio

nal t

eam

app

roac

h to

fall

prev

entio

n fo

r old

er h

ome

care

cl

ient

s ‘at

risk

’ of f

allin

g: h

ealth

car

e pr

ovid

ers s

hare

thei

r exp

erie

nces

. In

tern

atio

nal J

ourn

al o

f Int

egra

ted

Care

, 9, 1

-12.

Qua

litat

ive

Stud

y

des

crib

e th

e ex

peri

ence

of

5 d

iffer

ent h

ealth

care

pr

ofes

sion

als i

n a

ho

spic

e ce

ntre

CA

NA

dA

- G

ENER

Al

Inte

rpro

fess

iona

l tea

m

Ger

iatr

ic C

are

◥

Hig

h-le

vel c

olla

bora

tion,

co

ordi

natio

n, c

omm

unic

atio

n

◥Te

am m

embe

rs sh

are

a co

mm

on

goal

of fi

ndin

g so

lutio

ns to

co

mpl

ex p

atie

nt is

sues

◥

Expo

se p

rofe

ssio

nal b

ound

arie

s an

d st

ereo

type

s to

deve

lop

mut

ual

resp

ect a

nd tr

ust

◥

Hav

e a fl

exib

le en

viro

nmen

t, sh

arin

g in

form

atio

n an

d de

cisio

n-m

akin

g

No

spec

ific

clin

ical

out

com

es

Fact

ors t

o ac

hiev

e an

effe

ctiv

e IP

m

odel

for i

n-ho

me

care

: Effe

ctiv

e co

mm

unic

atio

n; R

ole

Cla

rity,

Incr

ease

d Tr

ust;

Avoi

d w

orki

ng

in si

los;

Tim

e m

anag

emen

t

7By

rnes

, v., O

’Rio

rdan

, A., S

chro

der,

C., C

hapm

an, C

., med

ves,

J.,

Pate

rson

, m., &

Gri

gg, R

. (20

12).

Sout

h Ea

ster

n In

terp

rofe

ssio

nal

Col

labo

rativ

e le

arni

ng E

nviro

nmen

t (S

EIPC

lE):

Nur

turi

ng C

olla

bora

tive

Prac

tice.

Jour

nal o

f Res

earc

h in

In

terp

rofe

ssio

nal P

ract

ice a

nd

Educ

atio

n, 2

(2),

168-

186.

Qua

si-C

ontr

olle

d Ex

plor

ator

y St

udy

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

Col

labo

ratio

n of

3 e

xist

ing

team

s; ac

ute,

reha

b, a

nd m

enta

l hea

lth

from

3 d

iffer

ent s

ites t

o pe

rfor

m

cont

rols

in a

sing

le si

te

◥In

terv

entio

n in

clud

ed o

nlin

e

◥an

d w

orks

hop

educ

atio

n, st

uden

t pl

acem

ent a

nd p

rece

ptor

ship

w

hich

was

inte

grat

ed in

to p

ract

ice

◥

Each

team

mem

ber r

ecor

ded

the

amou

nt o

f tim

e the

y sp

ent w

ith ea

ch

patie

nt in

each

stag

e of a

dmiss

ion

and

shar

ed d

ata t

o un

ders

tand

m

embe

r pro

gres

s and

roles

◥

Ove

rall

quan

titat

ive

data

di

d no

t sho

w st

atist

ical

ly

signi

fican

t res

ults

but

w

as p

ositi

ve tr

endi

ng –

in

terv

entio

n sit

es sh

owed

st

atist

ical

sign

ifica

nce

in

com

pari

son

to c

ontr

ol si

tes

◥

The

proj

ect p

rodu

ced

thre

e ed

ucat

iona

l mod

ules

, a g

uide

fo

r int

erpr

ofes

siona

l stu

dent

pl

acem

ents

and

thre

e w

orks

hops

◥

Prov

ided

val

idat

ion

of

the

CPA

T (C

olla

bora

tive

Prac

tice A

sses

smen

t Too

l)

8C

ioffi

, J., w

ilkes

, l., C

umm

ings

, J.,

war

ne, B

., & H

arri

son,

K. (

2010

). m

ultid

isci

plin

ary

team

s car

ing

for

clie

nts w

ith c

hron

ic c

ondi

tions

: Ex

peri

ence

s of c

omm

unity

nur

ses

and

allie

d he

alth

pro

fess

iona

ls.

Cont

empo

rary

Nur

se, 3

6(1-

2), 6

1-70

.

Qua

litat

ive

des

crip

tive

Stud

y

Ass

essin

g ex

peri

ence

s of

mul

tidis

cipl

inar

y te

am

mem

bers

in c

omm

unity

ch

roni

c ca

re te

ams

AuST

RAlI

AIn

terp

rofe

ssio

nal t

eam

Chr

onic

Tea

m

◥

At h

ome

appr

oach

,; A

llied

he

alth

pro

fess

iona

ls w

orki

ng

toge

ther

; nur

ses e

nsur

ing

that

pa

tient

s rec

eive

d th

e ca

re th

ey

need

ed in

ord

er to

pro

long

or

prev

ent h

ospi

taliz

atio

n

◥

Col

labo

ratio

n iss

ues i

n co

mm

unic

atio

n, co

hesiv

enes

s an

d ro

le cl

arity

caus

ing

tens

ion,

del

ays i

n re

ferr

als


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

9C

ôté,

G., l

auzo

n, C

., & K

yd-

Stri

ckla

nd, B

. (20

08).

Envi

ronm

enta

l sc

an o

f Int

erpr

ofes

siona

l co

llabo

ratio

n pr

actic

e in

itiat

ives

. Jo

urna

l of I

nter

prof

essio

nal C

are,

25(5

), 44

9-46

0.

Envi

ronm

enta

l Sca

n

Ott

awa

Hos

pita

l mod

el

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

In 2

008,

the

Otta

wa

Hos

pita

l la

unch

ed it

s pla

n to

inte

grat

e 80

team

s ove

r tw

o ye

ars a

cros

s 3

sites

to fu

lfill

the

Ont

ario

visi

on

for i

nteg

ratin

g in

terp

rofe

ssio

nal

care

in a

ll as

pect

s of h

ealth

care

◥

The O

ttaw

a H

ospi

tal

Inte

rpro

fess

iona

l mod

el o

f Prim

ary

care

(IPm

PC) w

as d

esig

ned

to

orga

nize

pat

ient

care

bet

wee

n he

alth

pro

fess

iona

ls fr

om d

iffer

ent

disc

iplin

es fa

ctor

ing

in th

eir

vario

us co

mpe

tenc

ies t

o cr

eate

the

mos

t effe

ctiv

e col

labo

rativ

e pat

ient

ce

ntre

d pr

actic

es

◥

Cre

ate

a na

tiona

l tre

nd o

f in

form

atio

n sh

arin

g in

ord

er

to im

prov

e an

d ex

pand

pa

tient

-cen

tred

car

e; m

ore

impo

rtan

ce b

eing

pla

ced

on

the

valu

e of

com

mun

icat

ion

◥

Tool

kits

hav

e be

en

deve

lope

d to

gui

de

othe

rs th

roug

h th

e in

terp

rofe

ssio

nal

colla

bora

tion

proc

ess

10Cr

aven

, m., &

Blan

d, R.

(200

6). B

ette

r Pr

actic

es in

Col

labor

ativ

e men

tal

Hea

lth C

are:

An

Ana

lysis

of t

he

Evid

ence

Bas

e. Ca

nadi

an Jo

urna

l of

Psy

chol

ogy,

51(1

), 1-

74.

Syst

emat

ic R

evie

w

Iden

tify B

ette

r Pra

ctice

s in

Col

labor

ative

men

tal H

ealth

GEN

ERA

lI n

terp

rofe

ssio

nal t

e am

(G

P &

Nur

se, C

linic

iens

, Pha

rmac

ists,

Psyc

hoth

erap

ists,

etc.

)

Prim

ary

Car

e –

men

tal H

ealth

Role

s of t

he N

urse

◥

Atte

nd e

duca

tiona

l int

erve

ntio

ns

◥

Stru

ctur

e as

sess

men

ts a

t var

ious

in

terv

als

◥

Follo

w-u

p ca

lls, e

mot

iona

l sup

port

◥

Form

ulat

e a

trea

tmen

t pla

n an

d dr

ug c

ouns

ellin

g

Fact

ors f

or su

cces

s: bu

ild o

n pr

e-ex

istin

g re

latio

nshi

ps, u

se o

f evi

denc

e bas

ed

guid

elin

es, s

uppo

rtiv

e ser

vice

stru

ctur

e

◥

Enha

nced

pat

ient

edu

catio

n

◥IP

wor

k ha

d a

posit

ive

effec

t on

dep

ress

ion

care

◥

mor

e co

nsum

er c

hoic

e ab

out

trea

tmen

t mod

ality


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

11d

avis,

P., C

lack

son,

J., H

enry

, C.,

Boby

n, J.

, & S

uveg

es, l

. (20

08).

Inte

rpro

fess

iona

l con

tinui

ng h

ealth

ed

ucat

ion

for d

iabe

tic p

atie

nts i

n an

urb

an u

nder

serv

ed c

omm

unity

. Jo

urna

l of I

nter

prof

essio

nal C

are,

22(1

), 51

-60.

Pilo

t Stu

dy

Eval

uatio

n Fi

ndin

gs

lear

ning

nee

ds o

f hea

lth

prof

essi

onal

s wor

king

w

ith u

nder

serv

ed

com

mun

ities

CA

NA

dA

- SA

SKAT

CHE w

ANIn

terp

rofe

ssio

nal t

eam

IC

EC ^

4

dia

bete

s Car

e

◥

This

IP te

am in

clud

es e

duca

tors

, nu

rses

, doc

tors

, phy

sical

ther

apist

s, ph

arm

acist

s, nu

triti

onist

s, ki

nesio

logi

sts,

and

dent

ists

◥

Serv

es 2

targ

et a

udie

nces

; urb

an

unde

rser

ved

com

mun

ity, a

nd

heal

th p

rofe

ssio

nals

◥

No

clin

ical

out

com

es

◥Fo

r thi

s mod

el to

wor

k, te

am

sizes

mus

t be

real

istic

, and

al

thou

gh te

am le

ader

s are

es

sent

ial n

o on

e pe

rson

is in

ch

arge

of t

akin

g al

l the

lead

s

◥Se

vera

l edu

catio

ns m

odel

s w

ere

deve

lope

d; In

tera

ctio

n w

ith th

e Pa

tient

and

his/

her

care

give

r; In

tera

ctio

n w

ith

com

mun

ity a

nd it

s res

ourc

es;

fam

ily c

onfe

renc

e 12

dem

iris,

G., w

ashi

ngto

n, K

., Oliv

er,

d.P

., & w

i tten

berg

-ly l

es, E

. (20

08).

A

stud

y of

info

rmat

ion

flow

in h

ospi

ce

inte

rdis

cipl

inar

y te

am m

eetin

gs.

Jour

nal o

f Int

erpr

ofes

siona

l Car

e, 22

(6),

621-

629.

Expl

orat

ory

Stud

y

det

erm

ine

the

flow

of

info

rmat

ion

in

hosp

ice

care

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Hos

pice

Car

e

◥

Inte

rdis

cipl

inar

y te

am in

clud

es

phys

icia

n, n

urse

, soc

ial w

orke

r, co

unse

llor

◥

Team

wor

ks o

n ca

re p

lan,

shar

es

goal

s and

resp

onsib

ilitie

s

◥

def

ined

lead

er n

eeds

to

be id

entif

ied

to a

ddre

ss/

reso

lve

issu

es

◥To

impr

ove

patie

nt/c

areg

iver

sa

tisfa

ctio

n, p

atie

nts/

fam

ilies

sh

ould

be

incl

uded

in

prog

ress

mee

tings


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

13d

iCen

so, A

., Bou

rgea

ult,

I., A

belso

n,

J., m

artin

-mis

ener

, R., K

aasa

lain

en,

S., C

arte

r, N

., & H

arbm

an, P

. (20

10).

util

izat

ion

of N

urse

Pra

ctiti

oner

s to

Incr

ease

pat

ient

Acc

ess t

o Pr

imar

y H

ealth

care

in C

anad

a: Th

inki

ng

Out

side

the

Box.

Nur

sing

Lead

ersh

ip,

23, 2

39-2

58.

Scop

ing

Rev

iew

Inte

grat

ion

of N

P

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

s

◥Tw

o m

odels

: B.C

. – in

tegr

atio

n of

N

Ps in

fee-

for-

serv

ice fa

mily

pra

ctice

cli

nics

; Ont

ario

– N

P-led

clin

ics

◥d

iscu

ssio

n of

fact

ors t

hat

supp

orte

d su

cces

s

◥B.

C. –

cle

ar p

roce

ss la

id o

ut b

y Re

gion

al H

ealth

Aut

horit

y fo

r ro

le in

trod

uctio

n, e

valu

atio

n an

d fo

llow

- thr

ough

; sup

port

ive

polic

ies,

infr

astr

uctu

re, p

ract

ice

envi

ronm

ent;

prom

ote

team

fu

nctio

ning

; mut

ual r

espe

ct; o

pen

and

regu

lar c

omm

unic

atio

n;

ongo

ing

clar

ifica

tion

of ro

les

◥

Cha

lleng

es fo

r sus

tain

abili

ty –

hi

erar

chy

– ph

ysic

ian

on to

p;

phys

icia

ns w

orrie

d ab

out w

orkl

oad

and

gaps

in th

eir o

wn

know

ledg

e; co

ncer

ns o

f NP

educ

atio

n;

conc

erns

for t

heir

own

stat

us

◥In

volv

e al

l phy

sicia

ns a

t clin

ic

in sh

ared

lead

ersh

ip in

stea

d of

just

one

as a

lead

phy

sicia

n;

invo

lve

othe

r pro

vide

rs/s

taff

to

unde

rsta

nd N

P ro

le

◥O

ntar

io –

faci

litat

ors –

larg

e nu

mbe

r of u

natta

ched

pat

ient

s; sh

orta

ge o

f phy

sicia

ns, a

vaila

bilit

y of

NPs

, loc

al m

edia

cov

erag

e, go

od w

orki

ng re

latio

nshi

ps w

ith

cons

ultin

g ph

ysic

ians

, hig

h pa

tient

sa

tisfa

ctio

n, N

P-le

d go

vern

ance

st

ruct

ure

(NP

as c

linic

dire

ctor

–

unde

rsta

nd th

e sc

ope)

◥

Cha

lleng

es –

hig

hly

com

plex

nee

ds

of p

atie

nts;

leng

thy

visit

s with

pa

tient

s; fr

eque

nt co

nsul

tatio

ns

with

phy

sicia

ns; c

ould

not

mee

t fir

st y

ear t

arge

ts d

ue to

leng

thy

visit

s; op

posit

ion

by o

rgan

ized

m

edic

ine –

conc

erns

that

NPs

are

inde

pend

ently

pra

ctic

ing

(issu

e m

ay b

e rel

ated

to ti

tle N

P-le

d)

◥

Hig

h pr

ovid

er a

nd

patie

nt sa

tisfa

ctio

n

◥C

reat

ed g

reat

er a

cces

s to

pri

mar

y ca

re


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

14d

ufou

r, S.

P., &

deb

orah

-luc

y, S.

(201

0). S

ituat

ing

Prim

ary

Hea

lthca

re w

ithin

the

Inte

rnat

iona

l C

lass

ifica

tion

of F

unct

ioni

ng,

disa

bilit

y, an

d H

ealth

: Ena

blin

g th

e C

anad

ian

Hea

lth T

eam

Initi

ativ

e. Jo

urna

l of I

nter

prof

essio

nal C

are,

24(6

), 66

6-67

7.

lite

ratu

re R

evie

w

Com

pari

son

of F

amily

H

ealth

Tea

ms (

FHT)

in

Ont

ario

to th

e

wH

O c

lass

ifica

tion

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

Prim

ary

Car

e

◥

The

FHT

is su

ppos

ed to

ad

dres

s loc

al n

eeds

and

pro

vide

co

mpr

ehen

sive

care

◥

This

incl

udes

a te

leph

one

heal

th

advi

sory

serv

ice,

an e

xpan

ded

hour

s pra

ctic

e, sp

ecia

lized

ou

tpat

ient

serv

ices

, hea

lth

prom

otio

n, c

hron

ic d

isea

se

man

agem

ent,

patie

nt-c

entr

ed c

are

◥

Gui

ding

pri

ncip

les o

f the

mod

el

incl

ude

flexi

bilit

y, ch

oice

, loc

al

inte

grat

ion,

tran

spar

ency

, co

nsul

tatio

n, a

nd fo

ster

ing

com

mun

ity p

artn

ersh

ips

◥

dis

cuss

ion

does

not

indi

cate

w

heth

er th

e m

odel

has

bee

n im

plem

ente

d or

not

◥

In o

rder

to a

chie

ve

optim

al o

utco

mes

the

follo

win

g fa

ctor

s nee

d to

be

cons

ider

ed: (

1) A

sses

smen

t of

com

mun

ity; (

2) S

elec

ting

the

mos

t app

ropr

iate

he

alth

care

pro

fess

iona

ls;

(3) Th

e tr

ansf

orm

atio

n pr

oces

s fro

m g

roup

to

colla

bora

tive

team

pra

ctic

e ne

eds t

o ta

ke p

lace

; (4

) leg

islat

ion

need

s to

be

mod

ified

and

app

ropr

iate

fu

ndin

g ne

eds t

o be

put

in

pla

ce

15G

abou

ry, I

., lap

ierr

e, l.

m., B

oon,

H.

& m

oher

, d. (

2011

). In

terp

rofe

ssio

nal

colla

bora

tion

with

in in

tegr

ativ

e he

alth

care

clin

ics t

hrou

gh th

e le

ns

of th

e re

latio

nshi

p –c

ente

red

care

m

odel

. Jou

rnal

of I

nter

prof

essio

nal

Care

, 25,

124

-130

.

Expl

orat

ory

Stud

y

Surv

eys w

ith p

ract

ition

ers

at th

e cl

inic

s

CA

NA

dA

- A

lBER

TAIn

terp

rofe

ssio

nal t

eam

Inte

grat

ed H

ealth

care

Clin

ics

Prim

ary

Car

e

◥

Prac

titio

ners

wor

king

toge

ther

in

clin

ic se

tting

s in

vary

ing

com

posit

ions

and

size

s. A

utho

rs

conc

lude

the

need

for t

eam

m

embe

rs to

und

erst

and

the

bene

fits o

f col

labo

ratio

n sk

ills.

◥

Prac

titio

ner b

ehav

iour

s an

d sk

ills a

ssoc

iate

d w

ith

job

satis

fact

ion


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

16G

aglia

rdi, A

.R., d

obro

w, m

. J., &

w

righ

t, F.

C. (

2011

). H

ow c

an w

e im

prov

e ca

ncer

car

e? A

revi

ew o

f In

terp

rofe

ssio

nal c

olla

bora

tion

mod

els a

nd th

eir u

se in

clin

ical

m

anag

emen

t. Jo

urna

l of S

urgi

cal

Onc

olog

y, 20

(3),

146-

154.

lite

ratu

re R

evie

w

Con

cept

ual m

odel

s of

colla

bora

tion

amon

g di

ffere

nt p

rofe

ssio

ns in

di

ffere

nt s

ettin

gs; f

ocus

on

clin

ical

man

agem

ent

of c

ance

r pat

ient

s

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

Can

cer C

are

– O

ncol

ogy

◥

All

mod

els o

f tea

mw

ork

and

colla

bora

tion

that

wer

e de

scrib

ed

invo

lved

two

or m

ore p

rofe

ssio

nals

that

shar

e pa

tient

goa

ls, fo

ster

ing

cont

inuo

us in

tera

ctio

n

◥Si

nce

canc

er p

atie

nts r

equi

re

mul

tiple

hea

lth p

rofe

ssio

nals,

co

llabo

rativ

e m

anag

emen

t and

sy

stem

atic

pla

nnin

g w

ill im

prov

e pa

tient

car

e

◥

Patie

nts w

ill b

enefi

t fro

m

bette

r pla

nned

and

enh

ance

d co

llabo

rativ

e ca

re a

nd

unde

rsta

ndin

g be

twee

n he

alth

pro

fess

iona

ls

17G

oldm

an, J

., meu

ser,

J., R

oger

s, J,

law

rie,

l., &

Ree

ves,

S. (2

010)

. In

terp

rofe

ssio

nal c

olla

bora

tion

in

fam

ily h

ealth

team

s. Ca

nadi

an F

amily

Ph

ysic

ian,

56,

368

-374

.

Qua

litat

ive

Cas

e St

udy

Exam

inin

g IP

C a

nd

its b

enef

its

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Fam

ily H

ealth

Tea

ms

Prim

ary

Car

e

◥

Gai

ning

insig

ht o

f FH

T m

embe

rs

and

thei

r exp

erie

nces

in th

eir r

oles

◥

Fam

ily h

ealth

team

s gen

eral

ly

cons

isted

of a

doc

tor,

nurs

e or

nu

rse

prac

titio

ner,

diet

itian

, soc

ial

wor

ker,

phar

mac

ist, a

nd o

ther

s

◥

Patie

nts a

re re

ceiv

ing

bette

r qu

ality

of c

are

but t

here

is

still

con

fusio

n ab

out

role

s, ne

ed fo

r mor

e te

am

lead

ers,

and

barr

iers

due

to

geo

grap

hy a

nd la

ck

of fo

llow

-ups

bet

wee

n pr

ofes

siona

ls in

volv

ed,

not p

atie

nts

◥

Sugg

estio

ns to

impr

ove

FHTs

incl

ude

mor

e in

terp

rofe

ssio

nal m

eetin

gs,

incr

ease

in E

mR

use,

mor

e tr

aini

ng a

nd re

thin

king

tr

aditi

onal

scop

e of

role

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

18H

aire

, B. (

2010

). In

terp

rofe

ssio

nal C

are:

A m

odel

of co

llabo

rativ

e pra

ctic

e. C

AN

Ad

A, P

rince

Edw

ard

Isla

nd.

Rep

ort

Eval

uatio

n Fr

amew

ork

to e

valu

ate

IPC

CA

NA

dA

- PR

INC

E Ed

wA

Rd

ISlA

Nd

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

Focu

s on

educ

atio

n an

d tr

aini

ng

to p

repa

re fu

ture

hea

lthca

re

wor

kers

to w

ork

in IP

setti

ngs

◥

Shar

e re

spon

sibili

ties,

acco

unta

bilit

y an

d de

velo

p

a fr

amew

ork

to b

road

en

the

scop

e of

wor

k

◥Pr

omot

e cul

tura

l cha

nge t

o aid

w

orke

rs in

adap

ting n

ew p

roce

dure

s, pr

actic

es an

d ex

pect

atio

ns

◥

For t

his I

P sy

stem

to w

ork,

pa

tient

s mus

t be

will

ing

to

adju

st th

eir e

xpec

tatio

ns o

f th

e he

alth

care

syst

em a

nd

resp

onsib

ility

of t

heir

own

heal

th a

nd w

elln

ess

19H

asse

lbac

k, P

., Sau

nder

s, d

., d

astm

alch

ian,

A., A

libha

i, A.,

Boud

reau

, R., C

hrei

m, S

., &

dÀ

gnon

e, K

. (20

03).

The

Tabe

r In

tegr

ated

Pri

mar

y C

are

Proj

ect:

Turn

ing

visi

on in

to R

ealit

y. Ca

nadi

an H

ealth

Ser

vice

s res

earc

h Fo

unda

tion,

1-2

9, R

etri

eved

from

: w

ww.

chrs

f.ca.

Pilo

t Eva

luat

ion

CA

NA

dA

RuRA

l A

lBER

TA

Inte

rpro

fess

iona

l tea

m

Rura

l, sm

all t

own

◥

Co-

loca

tion

of p

rovi

ders

◥

Alte

rnat

e pa

ymen

t sys

tem

–

ensu

re n

o fin

anci

al d

isinc

entiv

e

◥

Impr

oved

serv

ices

◥

Impr

oved

satis

fact

ion

of

reci

pien

ts


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

20H

illie

r, S.

l. (2

010)

. A S

yste

mat

ic

Revi

ew o

f Col

labo

rativ

e m

odel

s for

H

ealth

and

Edu

catio

n Pr

ofes

siona

ls w

orki

ng in

Sch

ool S

ettin

gs a

nd

Impl

icat

ions

for T

rain

ing.

Edu

catio

n fo

r Hea

lth, 2

3(3)

.

Syst

emat

ic R

evie

w

wha

t are

the

best

mod

els

to su

ppor

t col

labo

ratio

n be

twee

n ed

ucat

ion

and

heal

th st

aff

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

s

Hea

lthca

re S

choo

l Set

tings

◥

mul

tidis

cipl

inar

y: T

eam

mem

bers

w

ork

in is

olat

ion

but c

ontr

ibut

e

to m

ultid

isci

plin

ary

mee

tings

an

d pl

anni

ng

◥C

ase

man

agem

ent:

Cen

tral

per

son

taki

ng th

e le

ad o

n m

anag

ing

a sp

ecifi

c ca

se

◥C

onsu

ltatio

n: C

onsu

ltant

bri

ngs

expe

rtis

e an

d w

orks

with

the

clie

nt

thro

ugh

a m

edia

tor (

prof

essio

nal

wor

king

dire

ctly

with

the

clie

nt)

◥

Col

labo

ratio

n: A

t lea

st

2 in

divi

dual

s wor

king

toge

ther

to

war

ds a

com

mon

goa

l

◥Te

amin

g: O

rgan

ized

gro

up

of p

erso

nnel

, eac

h tr

aine

d in

a

diffe

rent

pro

fess

iona

l dis

cipl

ine;

coop

erat

ive

prob

lem

-sol

ving

◥

Inte

ract

ive

team

ing:

A fu

sion

of

con

sulta

tion

and

colla

bora

tion

◥

mod

el o

f ser

vice

shift

ed

from

‘’fixi

ng’’ t

he p

robl

em to

gr

eate

r und

erst

andi

ng; f

ocus

on

join

t dec

ision

- mak

ing

and

shar

ing

of re

spon

sibili

ty

◥Fo

r sch

ool c

hild

ren,

a

colla

bora

tive

appr

oach

from

he

alth

care

pro

fess

iona

ls an

d ed

ucat

ors f

oste

rs a

m

ore

holis

tic e

nviro

nmen

t, w

hich

is m

ore

bene

ficia

l and

po

sitiv

e fo

r the

m

◥H

ealth

care

pro

vide

rs

and

educ

ator

s nee

d tr

aini

ng a

nd su

ppor

ts

in in

terp

rofe

ssio

nal

colla

bora

tion


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

21H

owar

d, m

. (20

11).

Self-

repo

rted

te

amw

ork

in fa

mily

hea

lth te

am

prac

tices

in O

ntar

io. C

anad

ian

Fam

ily P

hysic

ian,

57,

185

-91.

Cro

ss S

ectio

nal S

tudy

Surv

ey d

one

on te

am

clim

ate

mea

sure

s to

det

erm

ine

the

func

tioni

ng o

f a F

HT

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

Fam

ily H

ealth

Tea

ms c

onsis

t of

allie

d he

alth

care

pro

fess

iona

ls in

pr

imar

y ca

re p

ract

ices

with

the

aim

to a

chie

ve h

ighe

r qua

lity

of

care

, pra

ctic

es, a

nd a

cces

sibili

ty

◥C

an b

e co

mpo

sed

of a

gro

up o

f pr

ofes

siona

ls at

a si

ngle

clin

ic o

r be

twee

n m

ultip

le o

ffice

s tha

t sha

re

prog

ram

s and

Em

Rs

◥u

sual

ly in

itiat

ed a

nd g

over

ned

by p

hysic

ians

◥

FHTs

show

pos

itive

tren

ds

whe

re th

ere

is st

rong

le

ader

ship

, the

shar

ing

of

EmRs

and

dev

elop

men

t of

cultu

re a

mon

g st

aff

22H

umbe

rt, J.

, leg

ault,

F., d

ahro

uge,

S., H

alabi

sky,

B., B

oyce

, G., &

Hog

g, w

. (20

09).

Inte

grat

ion

of n

urse

pr

actit

ione

rs in

to a

fam

ily h

ealth

ne

twor

k. Ca

nadi

an N

urse

, 103

(9),

30-3

4.

Ran

dom

ized

Con

trol

led

Tria

ls

Bene

fits o

f NPs

in F

HTs

to

man

age

at-r

isk

, at

-hom

e pa

tient

s with

ch

roni

c di

sabi

litie

s

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Ant

icip

ator

y an

d Pr

even

tive

Chr

onic

Car

e

◥

Eigh

teen

-mon

th st

udy

inte

grat

ing

thre

e N

Ps in

FH

Ts to

man

age

at-h

ome

and

at-r

isk p

atie

nts w

ith

chro

nic

disa

bilit

ies

◥

NP

wou

ld v

isit t

he p

atie

nt a

nd

crea

te a

car

e pl

an, v

erify

car

e pl

an

with

the

phys

icia

n, a

nd d

iscu

ss

med

icat

ions

with

the

phar

mac

ist

◥N

P al

so p

rovi

ded

exte

rnal

lin

ks fo

r the

pat

ient

to a

cces

s co

mm

unity

reso

urce

s

◥N

P so

lely

resp

onsib

le fo

r chr

onic

ill

ness

es; a

cute

illn

esse

s wer

e the

re

spon

sibili

ty o

f the

phy

sicia

n or

ER

◥

NP

used

a c

ompr

ehen

sive

heal

th

asse

ssm

ent t

o gu

ide

the

care

pla

n,

whi

ch w

as a

cces

sible

for o

ther

te

am m

embe

rs v

ia E

mR

◥

Patie

nts w

ere

very

satis

fied

with

the

leve

l of c

are

they

w

ere

prov

ided

from

the

NPs

◥

Phys

icia

ns d

ispla

yed

confi

denc

e an

d tr

ust i

n

the

leve

l of c

are

the

NPs

w

ere

prov

idin

g


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

23H

uron

Per

th H

ealth

care

Alli

ance

. (2

010)

. Inte

rpro

fess

iona

l Pra

ctice

mod

el.

Insti

tute

of m

edici

ne. (

2010

). Th

e fut

ure

of n

ursin

g: le

adin

g cha

nge,

adva

ncin

g he

alth.

was

hing

ton,

dC:

The N

atio

nal

Acad

emies

Pre

ss (p

repu

blica

tion

copy

). Re

triev

ed fr

om: h

ttp://

ww

w.na

p.ed

u/ca

talo

g/12

956.

htm

l.

Ove

rvie

w o

f the

H

uron

Per

th

Hea

lthca

re A

llian

ce

Inte

rpro

fess

iona

l Pr

actic

e m

odel

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Fam

ily-P

atie

nt F

ocus

ed C

are

◥

Prov

ide

inte

grat

ed a

sses

smen

ts

and

care

pla

ns fo

r the

pat

ient

ba

sed

on e

vide

nce-

info

rmed

pr

actic

e; RN

s and

RPN

s wor

king

in

col

labo

ratio

n

◥m

utua

l und

erst

andi

ng fo

r eac

h te

am m

embe

r’s ro

le; R

N d

eals

with

co

mpl

ex c

lient

s, RP

N h

andl

es le

ss-

risk

clie

nts

◥

Supp

ort p

rofe

ssio

nal d

evelo

pmen

t of

each

team

mem

ber;

plan

ning

and

impl

emen

ting c

ollab

orat

ive s

trate

gies

su

ch as

par

ticip

ator

y lea

ders

hip

◥

Impr

ove

patie

nt sa

fety

, qu

ality

of c

are,

satis

fact

ion

of p

atie

nts a

nd c

areg

iver

s th

roug

h ac

coun

tabi

lity,

part

ners

hip,

and

equ

ity

of te

am m

embe

rs

24la

copi

no, A

.m. (

2010

). m

odel

s for

In

terp

rofe

ssio

nal P

ract

ice:

Inno

vativ

e C

olla

bora

tion

Betw

een

Nur

sing

and

de n

tistr

y. Jo

urna

l of t

he C

anad

ian

Den

tal A

ssoc

iatio

n, 7

6(16

).

Prog

ram

Ove

rvie

w

dis

cuss

ion

on

colla

bora

tion

betw

een

NPs

and

de n

tal T

eam

s to

impr

ove

and

prom

ote

oral

aw

aren

ess

CA

NA

dA

- m

AN

ITO

BAIn

terp

rofe

ssio

nal t

eam

Nur

sing

and

den

tistr

y

◥

Col

labo

rativ

e edu

catio

nal e

xcha

nge;

Scho

ol o

f Nur

sing

mer

ging

with

the

Col

lege o

f den

tistr

y

◥N

urse

s tea

chin

g ab

out t

heir

prac

tice,

the

need

for r

efer

rals

and

awar

enes

s of p

atie

nt h

ealth

ri

sk p

rofil

es; d

entis

ts p

rovi

ding

te

achi

ng o

n or

al h

ealth

scre

enin

g an

d im

port

ance

◥

Exam

inin

g ho

w c

erta

in d

isea

ses

can

be c

o-m

anag

ed v

ia n

urse

and

de

ntist

scre

enin

g

◥

Patie

nts u

nder

stand

ing

the

impo

rtan

ce o

f see

king

den

tal

serv

ices

as w

ell as

prim

ary

care

serv

ices

impr

oved

; pa

tient

s wer

e ver

y op

en an

d ac

cept

ing

of o

ral h

ealth

chec

k-up

s and

den

tal r

efer

rals

◥

dem

onst

rate

d th

at n

urse

s can

im

prov

e acc

ess t

o or

al h

ealth

an

d al

so p

rom

ote d

iseas

e pr

even

tion

by w

orki

ng

alon

gsid

e den

tal t

eam

s and

be

ing

a pa

rt o

f the

firs

t-po

int

of co

ntac

t with

clie

nts


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

25le

gare

, F., P

oulio

tt, S

., Sta

cey,

d.,

des

roch

ers,

S., K

ryw

oruc

hko,

J.,

dun

n, S

., & E

lwyn

, G. (

2011

).In

terp

rofe

ssin

alism

and

shar

ed

deci

sion-

mak

ing

in p

rim

ary

care

: a

step

wis

e ap

proa

ch to

war

ds a

new

m

odel

. Jou

rnal

of I

nter

prof

essio

nal

Care

, 25,

18-

25.

Con

cept

ual P

aper

Ach

ievi

ng a

con

sens

us

on a

n IP

Sha

red

dec

isio

n m

akin

g m

odel

CA

NA

dA

- G

ENER

Al

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

Indi

vidu

al l

evel

: The

pat

ient

ca

n m

ake

a va

lue-

base

d in

form

ed d

ecis

ion

with

a te

am

of h

ealth

care

pro

fess

iona

ls

◥H

ealth

care

mes

o le

vel:

des

igni

ng

orga

niza

tiona

l rou

tines

and

hav

ing

a de

cisio

n co

ach

◥

Hea

lthca

re m

acro

lev

el:

und

erst

andi

ng th

e in

fluen

ce

of sy

stem

-leve

l fac

tors

; he

alth

pol

icie

s; pr

ofes

siona

l or

gani

zatio

ns; s

ocia

l con

text

◥

No

spec

ific

clin

ical

out

com

es

◥va

lidat

e the

mod

el am

ongs

t va

rious

stak

ehol

ders

; pat

ient

s, m

anag

ers,

polic

y m

aker

s; off

er IP

educ

atio

n; id

entif

y fa

ctor

s tha

t cou

ld aff

ect t

he

mod

el’s i

mpl

emen

tatio

n

26li

n, E

.H.B

., Kat

on, w

., Rut

ter,

C.,

Sim

on, G

.E., l

undm

an, E

.J., v

on-

Kor

ff, m

., & Y

oung

, B. (

2006

). Eff

ects

of

Enh

ance

d d

epre

ssio

n on

dia

bete

s Se

lf-C

are.

Anna

ls of

Fam

ily M

edic

ine,

4(1)

, 46-

53.

Ran

dom

ized

Con

trol

led

Tria

l (RC

T)

Exam

inin

g eff

ects

of

depr

essio

n in

terv

entio

ns

on se

lf-m

anag

ed

depr

esse

d di

abet

ic p

atie

nts

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

dia

bete

s

◥

Ran

dom

ize

Con

trol

led

Tria

l (R

CT)

incl

uded

329

pat

ient

s ac

ross

9 P

rim

ary

Car

e C

linic

s

◥Pa

tient

s in

the i

nter

vent

ion

grou

p w

ere r

ecei

ving

pha

rmac

othe

rapy

an

d pr

oble

m-s

olvi

ng su

ppor

t; ev

ery

few

mon

ths (

3,6,

12) p

atie

nts’

sum

mar

ies o

f dia

bete

s sel

f-car

e ac

tiviti

es w

ere l

ooke

d at

, alo

ng w

ith

pres

crip

tion

adhe

renc

e and

inta

ke

◥

Enha

nced

dep

ress

ion

care

an

d ou

tcom

es w

ere n

ot

asso

ciat

ed w

ith im

prov

ed

diab

etes

self-

care

beh

avio

rs;

no si

gnifi

cant

chan

ges i

n nu

triti

on, i

ncre

ased

phy

sical

ac

tivity

, or s

mok

ing

cess

atio

n;

min

or ch

ange

s in

BmI f

or

som

e pat

ient

s; no

diff

eren

ces

in m

edic

al a

dher

ence


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

27li

u, C

.F., H

edri

ck, S

.C., C

hane

y, E.

F.,

Hea

gert

y, P.

, Fel

ker,

B., &

Has

enbe

rg,

N. (

2003

). C

ost-

Effec

tiven

ess o

f C

olla

bora

tive

Car

e fo

r dep

ress

ion

in

a Pr

imar

y C

are v

e ter

an P

opul

atio

n.

Psyc

hiat

ric s

ervi

ces.

54(5

), 69

8-70

4.

Ran

dom

ized

Con

trol

led

Tria

l

Cos

t-effe

ctiv

enes

s of

a col

labo

rativ

e car

e in

terv

entio

n fo

r dep

ress

ion

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l te a

m

Prim

ary

Car

e –

men

tal H

ealth

◥

men

tal H

ealth

Tea

m (m

HT)

pr

ovid

es tr

eatm

ent p

lans

, te

leph

one

follo

w-u

ps, t

reat

men

t ad

here

nce,

resu

lts, m

odifi

catio

ns

to c

are

plan

◥Fo

cus o

n de

liver

ing

evid

ence

-bas

ed

trea

tmen

ts, b

ette

r com

mun

icat

ion

and

coor

dina

tion

of ca

re

◥

mH

Ts in

pri

mar

y ca

re

enab

le m

ore

patie

nts w

ith

men

tal i

llnes

s and

dep

ress

ion

to g

et sc

reen

ed a

nd c

are

◥

Incr

ease

d co

st a

nd

effec

tiven

ess o

f car

e

◥Pa

tient

s in

the

colla

bora

tive

care

mod

el w

ith th

e m

HT

rece

ived

pre

scrip

tions

for

anti-

depr

essa

nts a

nd w

ere

trea

ted

for d

epre

ssio

n

◥Pa

tient

s exp

erie

nced

14

.6 ad

ditio

nal d

epre

ssio

n-fre

e day

s ove

r the

nin

e-m

onth

stu

dy, r

esul

ting

in co

st sa

ving

s28

ludw

ig, K

. (20

07).

Patie

nts

Firs

t Pro

ject

: Fin

al R

epor

t. In

terp

rofe

ssio

nal N

etw

ork

of B

C.

Briti

sh C

olum

bia,

Can

ada.

Fina

l Rep

ort

How

to im

prov

e th

e qu

ality

of c

are

for F

irst

Nat

ion

com

mun

ities

in

nort

hern

BC

CA

NA

dA

- BR

ITIS

H

CO

lum

BIA

Inte

rpro

fess

iona

l tea

m

Abo

rigi

nal H

ealth

Car

e

◥

Eval

uatio

n of

cur

rent

in

terp

rofe

ssio

nal t

eam

s an

d ex

peri

ence

with

Fi

rst N

atio

n co

mm

uniti

es

◥Ed

ucat

ion

and

trai

ning

on

inte

rpro

fess

iona

l kno

wle

dge

and

skill

s for

hea

lthca

re p

ract

ition

ers

◥

Pres

enta

tions

, edu

catio

nal s

essio

ns,

and

conf

eren

ces w

ere o

rgan

ized

to

disc

uss fi

ndin

gs o

f the

pro

ject

◥

Firs

t Nat

ions

gro

ups s

till

appr

ehen

sive

of o

utsid

ers

◥

mor

e int

egra

tion

of ed

ucat

ion,

pr

actic

e, an

d po

licy;

susta

ined

by

the c

omm

unity

◥Es

tabl

ish st

rong

er co

nnec

tions

be

twee

n he

althc

are p

rovi

ders

in

the c

omm

unity

and

thos

e in

tend

ing t

o w

ork

with

the

com

mun

ity, i.

e. “u

nity

lear

ning

.’’


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

29m

acA

dam

, m. (

2008

). Fr

amew

orks

of

Inte

grat

ed C

are

for t

he E

lder

ly: A

Sy

stem

atic

Rev

iew.

Can

adia

n Po

licy

Rese

arch

Net

wor

ks, 1

-35.

Syst

emat

ic R

evie

w

How

to re

dire

ct c

are

from

inst

itutio

naliz

ed

serv

ices

and

focu

s on

case

man

agem

ent

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

s

Revi

ew o

f Int

egra

ted

Car

e m

odel

s; w

agne

r’s C

Cm

(Chr

onic

Car

e m

odel

); C

ase

man

agem

ent m

odel

s: PA

CE

mod

el, S

IPA

, PRI

S mA

)

PAC

E (P

rogr

am, A

ll-In

clusiv

e Car

e fo

r the

Eld

erly

): Jo

int r

even

ues,

case

m

anag

emen

t, m

ultid

iscip

linar

y te

am,

serv

ice d

eliv

ery

focu

s; pr

even

tion

focu

s, re

habi

litat

ion

and

supp

ortiv

e car

e

SIPA

(Sys

tem

of I

nteg

rate

d C

are f

or

Old

er P

erso

ns):

Con

trol o

f joi

nt fu

ndin

g, ca

se m

anag

emen

t with

mul

tidisc

iplin

ary

team

, use

of c

linic

al p

roto

cols,

inte

nsiv

e ho

me c

are,

24-h

our o

n-ca

ll av

aila

bilit

y, ra

pid

team

mob

iliza

tion)

PISm

A (I

nter

- and

intr

a-or

gani

zatio

nal

coor

dina

tion,

sing

le p

oint

of e

ntry

, cl

inic

al m

anag

emen

t, se

rvic

e co

ordi

natio

n vi

a ca

se te

am m

anag

ers

who

wor

k w

ith p

rovi

ders

, com

mon

as

sess

men

t ins

trum

ent,

clin

ical

cha

rt,

serv

ice

plan

, bud

getin

g of

serv

ices

in

tegr

ated

info

rmat

ion

syst

em

Succ

ess f

acto

rs: s

tron

g ph

ysic

ian

invo

lvem

ent,

com

mon

ass

essm

ent

and

care

pla

nnin

g to

ols,

inte

grat

ed

data

syst

ems;

umbr

ella

org

aniz

atio

nal

stru

ctur

e, m

ultid

isci

plin

ary

case

m

anag

emen

t, or

gani

zed

netw

ork

of

pro

vide

rs, fi

nanc

ial i

ncen

tives

vario

us: d

epen

ding

on

whi

ch ty

pe

of in

tegr

ated

syst

em w

as u

sed

◥

PAC

E: R

educ

ed h

ospi

tal

visit

s, lo

wer

mor

talit

y, im

prov

ed q

ualit

y of

life

an

d he

alth

stat

us, n

o st

rong

ev

iden

ce o

f cos

t sav

ings

◥

SIPA

: Inc

reas

e in

clie

nt

satis

fact

ion,

no

incr

ease

in

care

give

r bur

den,

no

over

all

cost

savi

ngs b

ut co

st- e

ffect

ive

◥

PRIS

mA

: Pro

misi

ng re

sults

, la

ck o

f out

com

e m

easu

res


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

30m

alin

, N., &

mor

row,

G. (

2007

). m

odel

s of i

nter

prof

essio

nal

wor

king

with

in a

Sur

e St

art

‘‘Tra

ilbla

zer’’

Pro

gram

me.

Jour

nal o

f In

terp

rofe

ssio

nal C

are,

21(4

), 44

5-45

7.

Qua

litat

ive

Stud

y (S

ingl

e C

ase

Stud

y d

esig

n)

des

crib

ing

IP w

ork

in

the “

trai

lbla

zer’’

pro

gram

uN

ITEd

K

ING

dO

mIn

terp

rofe

ssio

nal t

eam

Chi

ld C

are

Early

Sup

port

Clo

se g

ap in

out

com

es b

etw

een

child

ren

livin

g in

pov

erty

and

wid

er

child

pop

ulat

ion

◥

Sure

Sta

rt lo

cal p

rogr

ams p

rovi

de

outr

each

, hom

e vi

sitin

g, fa

mily

su

ppor

t, su

ppor

t for

goo

d qu

ality

pla

y, le

arni

ng, c

hild

care

ex

peri

ence

s, pr

imar

y an

d co

mm

unity

hea

lthca

re, a

dvic

e ab

out c

hild

and

fam

ily h

ealth

an

d de

velo

pmen

t and

supp

ort

for p

eopl

e w

ith sp

ecia

l nee

ds

(incl

udin

g he

lp in

acc

essin

g sp

ecia

lized

serv

ices

)

◥

Prog

ram

impr

oves

soci

al

and

emot

iona

l dev

elop

men

t, he

alth

, chi

ldre

n’s a

bilit

y to

le

arn,

stre

ngth

ens f

amili

es/

com

mun

ities

31m

anns

, B.J.

, Ton

elli,

m., Z

hang

, J.,

Cam

pbel

l, d

.J.T.

, Joh

nson

, J.,

& S

argi

ous,

P. (2

011)

. The

impa

ct

of p

rim

ary

care

net

wor

ks o

n th

e ca

re a

nd o

utco

mes

of p

atie

nts

with

dia

bete

s. Re

port

to A

lber

ta

Hea

lth a

nd w

elln

ess a

nd A

lber

ta

Hea

lth S

ervi

ces.

Retr

ieve

d fr

om:

Inte

rdis

cipl

inar

y C

hron

ic d

isea

se

Col

labo

ratio

n (w

ww.

ICd

C.c

a ).

Coh

ort S

tudy

Ana

lysi

s of s

tate

of

prim

ary

care

net

wor

ks

in A

lber

ta u

sing

a

coho

rt st

udy

of d

iabe

tic

patie

nts (

prev

alen

t vs.

inci

dent

dia

bete

s)

CA

NA

dA

- A

lBER

TAIn

terp

rofe

ssio

nal t

eam

Prim

ary

Car

e

◥

Prim

ary

Car

e N

etw

orks

(PC

N) –

38

as o

f Oct

ober

201

0. F

undi

ng

coul

d be

use

d to

hir

e nu

rses

. So

me

PCN

s offe

red

chro

nic

dise

ase

man

agem

ent t

o so

me

of

thei

r pat

ient

s whi

le o

ther

s offe

red

to a

ll. S

trat

egie

s use

d by

PC

Ns

incl

uded

: use

of E

mR

, pat

ient

re

min

ders

, clin

ical

rem

inde

rs,

audi

t and

feed

back

, fac

ilita

ted

rela

y of

pat

ient

dat

a, cl

inic

ian

educ

atio

n, p

atie

nt e

duca

tion,

pr

omot

ion

of se

lf-m

anag

emen

t, te

am c

hang

es, c

ase

man

agem

ent.

mo s

t com

mon

stra

tegi

es w

ere

team

cha

nges

and

pat

ient

ed

ucat

ion.

Non

-phy

sici

ans

pres

crib

ing

med

icat

ions

in h

alf

of P

CN

s.

◥

Bette

r gly

cem

ic c

ontr

ol, l

ess

ER v

isits

and

hos

pita

lizat

ion

amon

g di

abet

ic p

atie

nts


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

32m

artin

-mis

ener

, R., w

ambo

ldt,

B.d

., C

ain,

E., &

Giro

uard

, m. (

2009

). C

ost e

ffect

iven

ess a

nd o

utco

mes

of

a n

urse

pra

ctiti

oner

-par

amed

ic-

fam

ily p

hysic

ian

mod

el o

f car

e: Th

e lo

ng a

nd B

rier

Isla

nds s

tudy

. Pr

imar

y H

ealth

care

Res

earc

h an

d D

evelo

pmen

t, 10

, 14-

25.

long

itudi

nal S

tudy

CA

NA

dA

- N

OvA

SC

OTI

AIn

terp

rofe

ssio

nal t

eam

Rura

l Em

erge

ncy

Car

e

◥

Ons

ite N

P an

d pa

ram

edic

; off-

site

, phy

sici

an m

odel

◥

dec

reas

ed c

osts

(mos

tly

from

dec

reas

ed tr

avel

)

◥In

crea

sed

satis

fact

ion

◥

Incr

ease

d ac

cess

◥

Incr

ease

d eff

ectiv

e co

llabo

ratio

n

33m

a rtin

-mi s

ener

, R., m

cNab

, J.,

Sket

ris,

I.S., &

Edw

ards

, l. (

2004

). C

olla

bora

tive

prac

tice

in h

ealth

sy

stem

s cha

nge:

the

Nov

a Sc

otia

ex

peri

ence

with

the

stre

ngth

enin

g pr

imar

y ca

re in

itiat

ive.

Nur

sing

Lead

ersh

ip, 1

7(2)

, 33-

46.

Pers

pect

ive

Pape

r

Aut

hors

pro

vide

thei

r pe

rspe

ctiv

es o

n ho

w to

im

prov

e hea

lthca

re u

sing

the S

tren

gthe

ning

Prim

ary

Car

e Ini

tiativ

e (SP

CI)

CA

NA

dA

- N

OvA

SC

OTI

AIn

terp

rofe

ssio

nal t

eam

Prim

ary

Car

e

◥

Focu

s of t

he te

am w

as o

n ho

w to

in

trod

uce c

olla

bora

tive p

ract

ice

betw

een

prim

ary

heal

thca

re n

urse

pr

actit

ione

rs an

d fa

mily

phy

sicia

ns

◥A

im is

for t

he N

P to

wor

k al

ongs

ide

the

FP u

sing

met

hods

ot

her t

han

FSS,

and

inco

rpor

atin

g on

line

med

ical

pat

ient

reco

rds

◥

Goa

ls w

ere

to im

prov

e th

e re

spon

se to

the

com

mun

ity;

impr

ove

acce

ss to

car

e by

pr

omot

ing

illne

ss p

reve

ntio

n,

acco

unta

bilit

y an

d co

llabo

ratio

n

◥

Prov

ide

clea

r gui

delin

es

of re

spon

sibi

lity;

ens

urin

g th

at p

harm

acis

ts a

re

awar

e of

the

new

nur

se

pres

crip

tive

auth

ority

◥

Ensu

re th

e di

ssol

utio

n

of h

iera

rchi

es to

pro

mot

e co

llabo

ratio

n be

twee

n

FPs a

nd N

Ps

◥

Add

ress

issu

es o

f mal

prac

tice

and

liabi

lity

◥

Trea

ting

ambu

lato

ry c

are-

sens

itive

con

ditio

ns in

a

mor

e co

hesiv

e w

ay

34m

cNea

l, G

. (20

08).

um

dN

J Sch

ool

of N

ursin

g m

obile

Hea

lthca

re

Proj

ect:

A C

ompo

nent

of t

he N

ew

Jers

ey C

hild

ren’s

Hea

lth P

roje

ct.

ABN

F Jo

urna

l, 19

(4),

121-

128.

Cas

e St

udy

Exam

ples

of n

urse

-m

anag

ed h

ealth

cen

tres

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Am

bula

tory

Car

e

◥

Staff

inclu

ded

med

ical

dire

ctor

, pa

edia

tric

ian,

and

nurs

ing

assis

tant

◥

Nur

sing

ass

ista

nt w

ould

hel

p w

ith

scre

enin

gs, n

utri

tion

asse

ssm

ents

an

d im

mun

izat

ions

◥

Trea

ting

ambu

lato

ry c

are-

sens

itive

con

ditio

ns in

a

mor

e co

hesiv

e w

ay


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

35m

ills,

J.E., F

ranc

is, K

., Birk

s, m

., C

oyle

, m., H

ende

rson

, S. &

Jone

s, J.

(201

0). R

egist

ered

nur

ses a

s mem

bers

of

inte

rpro

fess

iona

l pri

mar

y he

alth

ca

re te

ams i

n re

mot

e or

isol

ated

ar

eas o

f Que

ensla

nd: C

olla

bora

tion,

co

mm

unic

atio

n an

d pa

rtne

rshi

ps in

pr

actic

e. Jo

urna

l of I

nter

prof

essio

nal

Care

, 24(

5), 5

87–5

96.

Com

mis

sion

ed m

ulti-

Cas

e R

esea

rch

Proj

ect

und

erst

andi

ng th

e ro

le o

f nu

rses

in re

mot

e se

tting

s

AuST

RAlI

AIn

terp

rofe

ssio

nal t

eam

Prim

ary

Car

e –

Rem

ote A

reas

◥

Col

labo

rativ

e de

cisi

on-m

akin

g in

clud

ing

case

con

fere

ncin

g

◥En

hanc

ing

exch

ange

of

info

rmat

ion

◥

Fost

erin

g st

rong

er re

latio

nshi

ps

◥

No

clin

ical

out

com

es

◥Re

sear

ch sh

owed

that

nur

ses

and

indi

geno

us w

orke

rs

frequ

ently

misu

nder

stand

on

e ano

ther

, so

colla

bora

tion

is es

sent

ial; e

stabl

ishin

g pa

rtne

rshi

ps an

d hi

gh le

vels

of

com

mun

icat

ion

will

impr

ove

heal

th se

rvic

es an

d ca

re36

min

ore,

B. &

Bon

e, m

. (20

02).

Real

izin

g po

tent

ial:

impr

ovin

g in

terd

isci

plin

ary

prof

essio

nal-

para

prof

essio

nal h

ealth

car

e te

ams

in C

anad

a’s n

orth

ern

abor

igin

al

com

mun

ities

thro

ugh

educ

atio

n.

Jour

nal o

f Int

erpr

ofes

siona

l Car

e, 16

(2),

139-

147.

Opi

nion

Pap

er

Enha

ncin

g he

alth

hum

an

reso

urce

s in

rura

l are

as

with

the

Hea

lth H

uman

Re

sour

ce m

odel

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Hea

lth H

uman

Res

ourc

e m

odel

◥

This

mod

el co

nsist

s of m

enta

l he

alth

wor

kers

, com

mun

ity h

ealth

w

orke

rs, a

nd a

lcoh

ol an

d ad

dict

ion

prog

ram

wor

kers

wor

king

al

ongs

ide p

rimar

y ca

re n

urse

s

◥Th

is m

odel

was

des

igne

d to

hel

p fil

l in

gaps

in ru

ral a

nd re

mot

e ar

eas w

here

recr

uitm

ent o

f hea

lth

prof

essi

onal

s is d

ifficu

lt

◥

No

clin

ical

out

com

es

◥m

odel

will

wor

k eff

ectiv

ely

if in

divi

dual

s inv

olve

d re

ceiv

e ad

ditio

nal i

nstr

uctio

n,

(clin

ical

, int

erpr

ofes

siona

l, cu

ltura

l, co

mm

unic

atio

nal)

to o

ptim

ize

the

heal

th

hum

an re

sour

ces m

odel

in

orde

r to

mee

t the

nee

ds o

f un

ders

erve

d cl

ient

s

37N

icho

las,

d.B

. (20

10).

Exam

inin

g or

gani

zatio

nal c

onte

xt a

nd a

de

velo

pmen

tal f

ram

ewor

k in

ad

vanc

ing

inte

rpro

fess

iona

l co

llabo

ratio

n: A

cas

e st

udy.

Jour

nal

of In

terp

rofe

ssio

nal C

are,

24(3

), 31

9–32

2.

Cas

e St

udy

Exam

inin

g in

terp

rofe

ssio

nal

colla

bora

tion

at

Toro

nto’s

Hos

pita

l for

Si

ck K

ids

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Sick

Kid

s mod

el

◥

The

core

of t

his m

odel

is c

entr

ed

arou

nd fa

mily

-cen

tred

car

e an

d th

e in

clus

ion

of a

bro

ad sp

ectr

um

of st

akeh

olde

rs

◥

No

clin

ical

out

com

e

◥m

odel

can

be

adva

nced

th

roug

h a

mul

ti-la

yer

appr

oach

, and

fam

ily

incl

usio

n ha

s bee

n a

t op

app

roac

h

◥Th

e ‘’fa

mily

-cen

tred

care

ad

viso

ry co

unci

l’’ ha

s bee

n

an im

port

ant c

ompo

nent

of

IP a

dvan

cem

ent i

nclu

ding

pl

anni

ng, o

pera

tions

, an

d ev

alua

tion


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

38N

orth

wes

t Ter

ritor

ies H

ealth

and

So

cial

Ser

vice

s. (2

004)

. Int

egra

ted

Serv

ice

del

iver

y m

odel

for t

he N

wT

Hea

lth a

nd S

ocia

l Ser

vice

s Sys

tem

: A

det

aile

d d

escr

iptio

n. P

rimar

y H

ealth

care

Tra

nsiti

on F

und:

Hea

lth

Cana

da, 1

-168

.

des

crip

tive A

naly

sis

Ove

rvie

w o

f the

In

tegr

ated

Ser

vice

d

eliv

ery

mod

el S

trat

egy

for N

orth

wes

t Ter

ritor

ies

CA

NA

dA

- N

wT

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e

◥

A h

ealth

and

soci

al se

rvic

es

orga

niza

tion

with

a v

ertic

al

and

hori

zont

al a

ppro

ach

that

is

seam

less

and

com

preh

ensi

ve, w

ith

a st

rong

clie

nt-c

entr

ed fo

cus

◥

Aim

is to

pro

vide

tran

spar

ent,

com

pete

nt, a

nd su

stai

nabl

e ca

re w

ith q

ualit

y as

sura

nce

and

cont

inui

ty, w

ith ro

om fo

r on-

goin

g ev

alua

tions

◥

The

succ

ess o

f thi

s mod

el

depe

nds l

arge

ly o

n th

e ab

ility

to

recr

uit,

reta

in, a

nd re

trai

n st

aff w

hen

nece

ssar

y

◥En

suri

ng th

at c

olla

bora

tion

is ta

king

pla

ce a

t a re

gion

al

and

terr

itori

al le

vel

◥

Cre

atin

g a

para

digm

shift

th

at p

rom

otes

a w

elln

ess

mod

el o

ver a

n ill

ness

mod

el,

easin

g th

e bu

rden

on

the

heal

thca

re sy

stem

39O

’Bri

en, J

.l. (

2009

). A

ph

enom

enol

ogic

al p

ersp

ectiv

e on

adv

ance

d pr

actic

e nu

rse–

phys

icia

n co

llabo

ratio

n w

ithin

an

inte

rdis

cipl

inar

y he

alth

care

team

. Jo

urna

l of t

he A

mer

ican

Aca

dem

y of

N

urse

Pra

ctiti

oner

s, 21

, 444

–453

.

Phen

omen

olog

ical

Pe

rspe

ctiv

e

Expe

rien

ces o

f A

dvan

ced

Prac

tice

Nur

ses a

nd P

hysi

cian

s in

a n

ursi

ng h

ome

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Focu

s on

APN

and

phy

sicia

n co

llabo

ratio

n in

mul

tisite

nur

sing

hom

e pr

actic

e

◥

Impr

ovin

g th

e co

mm

unic

atio

n,

acco

mm

odat

ion,

und

erst

andi

ng

info

rmat

ion

and

know

ledg

e-ex

chan

ge b

etw

een

phys

icia

ns a

nd

adva

nced

pra

ctic

e nu

rses

◥

Nur

se-p

hysic

ian

rela

tions

hips

impr

oved

in

setti

ngs w

here

team

wor

k is

vita

l: op

erat

ing

room

s, in

tens

ive

care

uni

ts

◥Fo

cus o

n im

prov

ing

phys

icia

n’s u

nder

stan

ding

of

the

NP

role

, sco

pe o

f pra

ctic

e to

enh

ance

trus

t/res

pect

40O

dega

rd, A

., Hag

tvet

,K.A

., & B

jork

ly,

S. (2

008)

. App

lyin

g as

pect

s of

gene

raliz

abili

ty th

eory

in p

relim

inar

y va

lidat

ion

of th

e m

ultif

acet

In

terp

rofe

ssio

nal C

olla

bora

tion

mod

el (P

INC

Om

). In

tern

atio

nal

Jour

nal o

f Int

erpr

ofes

siona

l Car

e, 8(

17),

1568

-415

6.

Empi

rica

l Ass

essm

ent

Ass

essm

ent o

f the

IP

C m

odel

with

the

Gen

eral

izab

ility

Theo

ry

(GT)

NO

RwAY

Inte

rpro

fess

iona

l tea

m

Chi

ldre

n an

d yo

uth

in m

enta

l hea

lth

doe

s not

pro

vide

muc

h on

the

mod

els

◥

Stud

y ill

ustr

ates

that

in c

ontr

ast

to te

st c

onst

ruct

ion

with

in th

e cl

assi

cal t

est t

heor

y fr

amew

ork,

G

T gi

ves n

ew p

ossi

bilit

ies f

or

eval

uatin

g te

st sc

ores

◥

GT

high

light

s bot

h va

lidity

and

re

liabi

lity

issu

es, i

mpo

rtan

t in

mea

suri

ng o

f IPC

◥

IPC

mea

sure

men

t stil

l in

early

pha

ses o

f dev

elop

men

t

◥N

eed

for c

lear

er d

efini

tions


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

41Pa

uzé E

., Gag

né, m

.A., &

Pau

tler,

K.

(200

5). C

olla

bora

tive m

enta

l hea

lth

care

in p

rimar

y he

alth

care

: A re

view

of

Can

adia

n in

itiat

ives

. Vol

ume I

: An

alys

is of

Initi

ativ

es –

Can

adia

n Co

llabo

rativ

e Men

tal H

ealth

Initi

ativ

e; 1-

102.

Retr

ieve

d fr

om: w

ww.

ccm

hi.ca

.

Revi

ew

Key

them

es/tr

ends

in

colla

bora

tive m

enta

l hea

lth

CA

NA

dA

- G

ENER

Al

Inte

rpro

fess

iona

l tea

m

Prim

ary

Car

e –

men

tal H

ealth

Thre

e ap

proa

ches

with

phy

sicia

ns,

nurs

es, p

sych

iatr

ists

1.

dir

ect:

men

tal h

ealth

spec

ialis

ts

offer

thei

r ser

vice

s 2.

In

dire

ct a

ppro

ach:

pri

mar

y he

alth

care

pro

vide

r del

iver

ing

men

tal h

ealth

serv

ices

with

the

cons

ulta

tive

supp

ort o

f a m

enta

l he

alth

spec

ialis

t3.

C

ombi

natio

n of

dir

ect/

indi

rect

◥

No

spec

ific

clin

ical

out

com

es

◥A

com

bine

d ap

proa

ch to

m

enta

l hea

lth is

pre

ferr

ed;

cons

umer

s sho

uld

be

invo

lved

in al

l asp

ects

of

thei

r car

e, th

eir k

now

ledg

e an

d ex

pert

ise sh

ould

not

be

unde

rval

ued

whe

n de

velo

ping

, im

plem

entin

g, an

d ev

alua

ting

colla

bora

tive a

ctiv

ities

42Pe

tri,

l. (2

010)

. Con

cept

Ana

lysis

of

Inte

rdis

cipl

inar

y C

olla

bora

tion.

N

ursin

g Fo

rum

, 45(

2), 7

2-81

.

Con

cept

Ana

lysis

wha

t is t

he m

eani

ng

of in

terp

rofe

ssio

nal

colla

bora

tion

with

in th

e he

alth

care

cont

ext

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

*No

spec

ific

mod

el is

exa

min

ed in

th

is st

udy

◥

Trad

ition

ally

, IPC

is d

escr

ibed

as a

pr

oble

m-f

ocus

ed p

roce

ss, s

hari

ng,

and

wor

king

toge

ther

◥In

terp

rofe

ssio

nal e

duca

tion,

ro

le a

war

enes

s, in

terp

erso

nal

rela

tions

hip

skill

s, de

liber

ate

actio

n, a

nd su

ppor

t sho

uld

be

pres

ent f

or IP

C to

be

bene

ficia

l fo

r the

pat

ient

, org

aniz

atio

n,

heal

thca

re p

rovi

der

mor

e com

preh

ensiv

e defi

nitio

n of

IPC

: pro

cess

by

heal

thca

re

prof

essio

nals

with

shar

ed

obje

ctiv

es, d

ecisi

on-m

akin

g, re

spon

sibili

ty, a

nd p

ower

wor

king

to

geth

er to

solv

e pat

ient

care

pr

oblem

s; be

st at

tain

ed th

roug

h an

inte

rpro

fess

iona

l edu

catio

n th

at p

rom

otes

an at

mos

pher

e of

mut

ual t

rust

and

resp

ect,

open

co

mm

unic

atio

n, aw

aren

ess,

acce

ptan

ce o

f rol

es, s

kills

, and

re

spon

sibili

ties o

f the

par

ticip

atin

g di

scip

lines

(pg.

80)


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

43Pi

ttam

, G., S

ecke

r, J.,

& F

ord,

F. (2

010)

. Th

e rol

e of i

nter

prof

essio

nal w

orki

ng

in th

e Pat

hway

s to

wor

k C

ondi

tion

man

agem

ent P

rogr

amm

es. J

ourn

al o

f In

terp

rofes

siona

l Car

e, 24

(6),

699–

709.

Pilo

t Stu

dy in

cludi

ng

qual

itativ

e eva

luat

ions

Con

trib

utin

g to

a

real

istic

eval

uatio

n of

the

Con

ditio

n m

anag

emen

t Pr

ogra

m (C

mP)

im

plem

ente

d in

7 u

.K.

pilo

t site

s

uN

ITEd

K

ING

dO

mIn

terp

rofe

ssio

nal t

eam

Hea

lth a

nd E

mpl

oym

ent C

are

◥

Con

ditio

n m

anag

emen

t Pr

ogra

ms:

focu

s on

pain

m

anag

emen

t, pr

omot

ion

of

exer

cise

, hea

lthy

lifes

tyle

s, st

ress

man

agem

ent,

confi

denc

e-bu

ildin

g, a

nxie

ty, d

epre

ssio

n

◥Fo

cus o

n de

velo

ping

per

sona

l w

orki

ng re

latio

nshi

ps, d

evel

opin

g le

vels

of tr

ust w

ith p

atie

nts

◥

Team

s mem

bers

reco

gniz

ed

that

thei

r con

trib

utio

n w

as

part

of a

larg

er p

roce

ss

◥A

llow

ed p

atie

nts t

o ta

ke th

e le

ad in

thei

r car

e

44Po

mey

, m.P

., mar

tin, E

., & F

ores

t, P.

G.

(200

9). Q

uebe

c`s F

amily

med

icin

e G

roup

s: In

nova

tion

and

Com

prom

ise

in th

e Re

form

of F

ront

-lin

e C

are.

Cana

dian

Pol

itica

l Sci

ence

Rev

iew,

3(

4), 3

1-46

.

disc

ussio

n Pa

per

CA

NA

dA

- Q

uEB

ECIn

terp

rofe

ssio

nal t

eam

Fam

ily m

edic

ine

Gro

up

◥

Gro

ups o

f 6-1

2 do

ctor

s who

w

ork

with

oth

er p

rovi

ders

; hav

e re

gist

ered

pat

ient

s; pr

ovid

e co

mpr

ehen

sive p

rimar

y ca

re

serv

ices

– co

ntin

uity

of c

are –

co

ordi

natio

n of

serv

ices

with

oth

er

syst

em p

rovi

ders

; acc

essib

le fo

r aft

er-h

ours

nee

ds; a

lso re

ason

able

tim

e to

get a

ppoi

ntm

ent

◥

Serv

ice

agre

emen

ts w

ith C

SlC

◥

Agr

ee to

rem

uner

atio

n sc

hem

a

◥

Not

appl

icab

le


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

45R

agaz

, N., B

erk,

A., F

ord,

d., &

m

orga

n, m

. (20

10).

Stra

tegi

es fo

r fa

mily

hea

lth te

am le

ader

ship

: le

sson

s lea

rned

by

succ

essf

ul te

ams.

Hea

lthca

re Q

uart

erly,

13(

3), 3

9-43

.

des

crip

tive C

ase S

tudi

es

of fi

ve F

HTs

(Fam

ily

Hea

lth T

eam

s)

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Hos

pice

Car

e

◥

This

artic

le re

view

ed 5

FH

Ts in

5

diffe

rent

loca

tions

; inc

lude

d a c

olla

bora

tion

of n

urse

s, nu

rse

clini

cian

s, do

ctor

s, di

etiti

ans,

soci

al w

orke

rs, h

ealth

pro

mot

ers,

phar

mac

ists,

and

CC

AC

case

m

anag

ers d

epen

ding

on

the l

ocat

ion

◥

This

mod

el fo

cuse

d on

the

educ

atio

n of

team

mem

bers

with

ro

le c

lari

ficat

ion,

und

erst

andi

ng

the

valu

e of

the

RN, a

nd a

ligni

ng

the

FHT

with

the

min

istr

y of

H

ealth

lon

g-Te

rm C

are

Plan

◥

Patie

nts w

ill b

enefi

t fro

m

havi

ng th

e app

ropr

iate

re

ferr

als t

ake p

lace

in

one l

ocat

ion;

hav

ing

spec

ialis

ts co

nduc

t ong

oing

ev

alua

tions

, sha

ring

acco

mpl

ishm

ents,

adap

ting

to n

ew an

d un

expe

cted

iss

ues,

data

-sha

ring,

and

open

co

mm

unic

atio

n

◥Th

e use

of E

mRs

was

ev

alua

ted

and

deem

ed cr

itica

l to

faci

litat

e and

pro

vide

bet

ter

care

to p

atie

nts

46Re

eves

, S., Z

war

enste

in, m

., Gol

dman

, J.,

Barr,

H., F

reet

h, d

., Ham

mick

, m.,

& K

oppe

l, I. (2

009)

. Inte

rpro

fessio

nal

educ

atio

n: eff

ects

on p

rofes

siona

l pr

actic

e and

hea

lth ca

re o

utco

mes

. Co

chra

ne D

atab

ase o

f Sys

temat

ic Re

view

s, 1(

Cd00

2213

), dO

I:10.1

002/

1465

1858

.Cd

00 22

13.p

ub2.

Syst

emat

ic R

evie

w

Impr

ovin

g in

terp

rofe

ssio

nal

colla

bora

tion

and

patie

nt c

are

thro

ugh

inte

rpro

fess

iona

l ed

ucat

ion

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

*Ass

essm

ent,

no sp

ecifi

c m

odel

(s)

outli

ned

◥

Ass

essi

ng d

iffer

ent r

ando

miz

ed

cont

rol t

rial

s and

the

valu

e of

in

terp

rofe

ssio

nal e

duca

tion

(IPE

)

◥Is

IPE

mor

e eff

ectiv

e fo

r IPC

te

ams i

n co

ntra

st to

edu

catio

n in

terv

entio

ns in

whi

ch th

e sa

me

heal

th a

nd so

cial

car

e pr

ofes

sion

als l

earn

sepa

rate

ly

from

one

ano

ther

◥

Onl

y 6

studi

es ex

amin

ed; a

fe

w d

emon

strat

ed p

ositi

ve

chan

ges w

hen

usin

g IP

E

◥m

ore

rese

arch

nee

ds to

be

done

on

how

IPE

affec

ts

the

heal

thca

re p

roce

ss a

nd

patie

nt o

utco

mes


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

47Ro

blin

, d.w

. (20

03).

Prim

ary

Hea

lth

Car

e Te

ams O

ppor

tuni

ties a

nd

Cha

lleng

es in

Eva

luat

ion

of S

ervi

ce

del

iver

y In

nova

tions

. J A

mbu

lato

ry

Care

Man

age,

26(1

), 22

–35.

des

crip

tive A

rtic

le

des

crib

ing

thre

e m

odel

s of

pri

mar

y he

alth

care

te

ams;

impl

emen

ting

chan

ges,

plan

ning

, and

ev

alua

tion

oppo

rtun

ities

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Prim

ary

Hea

lthca

re T

eam

s

◥

Stro

ng fo

cus o

n

orga

nizi

ng/im

plem

entin

g

fam

ily h

ealth

care

team

s

◥Te

ams c

onsi

sted

of

vari

ous m

embe

rs: p

hysi

cian

s, re

gist

ered

nur

ses,

nurs

e pr

actit

ione

rs, b

ehav

iour

al

spec

ialis

ts, h

ealth

edu

cato

rs

◥Fo

cus o

n ch

angi

ng o

bser

vatio

n an

d ex

pert

ise

in p

atie

nt c

are,

mor

e co

ncen

trat

ion

on c

ontin

uity

of

car

e se

rvic

e or

ient

atio

n

◥

Pote

ntia

l to

impr

ove

syst

em p

rodu

ctiv

ity, p

atie

nt

satis

fact

ion,

clin

ical

qua

lity,

empl

oyee

mor

ale

◥

Pote

ntia

l to

low

er c

are

deliv

ery

cost

s

48Ro

sser

, w.w

., Col

will

, J.m

., Kas

pers

ki,

J., &

wils

on, l

. (20

11).

Prog

ress

of

Ont

ario

’s fa

mily

hea

lth te

am m

odel

: A

patie

nt-c

entr

ed m

edic

al h

ome.

Anna

ls of

Fam

ily M

edici

ne, 9

(2),

165-

171.

des

crip

tive A

rtic

le

des

crib

ing

the

deve

lopm

ent,

impl

emen

tatio

n,

reim

burs

emen

t and

cu

rren

t sta

tus o

f the

FH

T

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Fam

ily H

ealth

Tea

m

Prim

ary

Car

e

◥

This

mod

el w

as c

alle

d th

e Pa

tient

-Cen

tred

Pri

mar

y C

are

Col

labo

rativ

e m

odel

◥

The

focu

s of t

he m

odel

is o

n ad

voca

cy fo

r the

pat

ient

, ens

urin

g th

at p

rope

r ref

erra

ls an

d he

alth

as

sess

men

ts ta

ke p

lace

; edu

catio

n an

d on

-goi

ng c

ouns

ellin

g an

d fo

llow

-ups

for t

he p

atie

nt, a

nd

24 h

ours

a d

ay/7

day

s a w

eek

resp

onse

for t

he p

atie

nt

◥

Incr

ease

the n

umbe

r of

resid

ents

bein

g tr

aine

d in

fa

mily

med

icin

e will

faci

litat

e th

e wor

k of

the p

hysic

ians

w

ho w

ere b

eing

ove

rload

ed

with

pat

ient

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

49Ru

ssel

, G.m

., dab

roug

e, S.

, Hog

g, w

., G

enea

u, R

., mul

doon

, l., &

mel

tem

, T.

(200

9). m

anag

ing

chro

nic

dise

ase

in O

ntar

io p

rim

ary

care

: The

impa

ct

of o

rgan

izat

iona

l fac

tors

. Ann

als o

f Fa

mily

Med

icin

e, 7(

4), 3

09-3

17.

Cro

ss-S

ectio

nal S

tudy

(Q

ualit

ativ

e C

ase

Stud

ies)

Ass

essin

g fo

ur ty

pes o

f m

odel

s add

ress

ing

chro

nic

dise

ase m

anag

emen

t

CA

NA

dA

- O

NTA

RIO

Inte

rpro

fess

iona

l tea

m

Chr

onic

dis

ease

Car

e

4 m

odel

s

◥

Com

mun

ity H

ealth

Cen

tre

(CH

C) –

foun

d to

be

supe

rior

in

man

agem

ent o

f chr

onic

di

seas

e –

long

er c

onsu

ltatio

n tim

e fo

r pat

ient

s and

gre

ater

in

terp

rofe

ssio

nal c

olla

bora

tion;

pr

esen

ce o

f NP

◥

Fee

for s

ervi

ce (F

FS)

◥

Fam

ily h

ealth

net

wor

k (F

HN

)

◥H

ealth

serv

ice

orga

niza

tion

(HSO

)

◥

In a

ll fo

ur c

ases

, offi

ces

with

few

er th

an 4

fam

ily

phys

icia

ns w

ere

foun

d to

be

mor

e eff

ectiv

e in

chr

onic

di

seas

e m

anag

emen

t

◥Q

ualit

y of

care

incr

ease

d w

hen

a nu

rse p

ract

ition

er

was

invo

lved

, as t

he n

urse

pr

actit

ione

r hel

ps to

de

crea

se th

e wor

kloa

d of

th

e phy

sicia

n; th

e nur

se

prac

titio

ner h

as th

e flex

ibili

ty

to o

rgan

ize c

are m

anag

emen

t ac

tiviti

es, i

mpr

ovin

g th

e st

anda

rd o

f car

e for

pat

ient

s50

Schr

aede

r, C

., Fra

ser,

C.w

., Cla

rk, I

., lo

ng, B

., She

lton,

P., w

alds

chm

idt,

v.,

& K

ucer

a, C

.l. (

2008

). Ev

alua

tion

of a

pr

imar

y ca

re n

urse

cas

e m

anag

emen

t in

terv

entio

n fo

r chr

onic

ally

ill

com

mun

ity d

wel

ling

olde

r peo

ple.

Jour

nal o

f Nur

sing

and

Hea

lthca

re o

f Ch

roni

c Illn

ess,

17, 4

07-4

17.

Non

-Ran

dom

ized

Stu

dy

Effec

tiven

ess o

f a

colla

bora

tive

prim

ary

are

nurs

e ca

se m

anag

emen

t in

terv

entio

n em

phas

izin

g co

llabo

ratio

n be

twee

n ph

ysic

ians

, nur

ses

and

patie

nts

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Nur

se C

ase

man

agem

ent I

nter

vent

ion

◥

PHC

T (P

rim

ary

Hea

lthca

re

Team

) nur

ses a

nd p

rim

ary

care

ph

ysic

ians

wor

king

toge

ther

to

impr

ove

risk

iden

tifica

tion,

co

mpr

ehen

sive

asse

ssm

ents

, sh

ared

pla

nnin

g, b

ette

r pat

ient

ed

ucat

ion

and

mon

itori

ng, s

moo

th

tran

sitio

n of

car

e, m

ore

effec

tive

use

of h

ealth

care

reso

urce

s for

ch

roni

cally

ill o

lder

pat

ient

s

◥St

udy

look

ed a

t the

diff

eren

ces

betw

een

a tr

eatm

ent g

roup

and

co

mpa

riso

n gr

oup

◥

Trea

tmen

t gro

up re

sulte

d in

less

re-h

ospi

taliz

atio

n,

whi

ch sa

ved

on h

ospi

tal

cost

s, (n

o ot

her s

tatis

tical

ly

sign

ifica

nt re

sults

)

◥C

hron

ic c

are

inte

rven

tion

that

incl

udes

col

labo

ratio

n be

twee

n ph

ysic

ians

, nur

ses

and

patie

nts,

may

be

mor

e eff

ectiv

e if

appl

ied

in

inte

grat

ed p

rovi

der n

etw

orks


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

51Sc

hrae

der,

C., v

olla

nd, P

., & G

olde

n,

R. (2

011)

. Pro

misi

ng m

odel

s of C

are

Coo

rdin

atio

n fo

r Ben

efici

arie

s with

C

hron

ic Il

lnes

ses.

Agin

g in

Am

eric

a,

Pow

erPo

int S

lides

1-3

1.

Pres

enta

tion

Slid

esu

NIT

Ed

STAT

ESIn

terp

rofe

ssio

nal t

eam

Chr

onic

dis

ease

man

agem

ent

Tran

sitio

nal c

are

inte

rven

tions

◥

Car

e Tr

ansit

ions

Inte

rven

tion

(Col

eman

)

◥Tr

ansit

iona

l Car

e m

odel

(Nay

lor)

◥

Enha

nced

dis

char

ge P

lann

ing

Prog

ram

– R

uSH

(Per

ry)

Com

preh

ensiv

e C

are

man

agem

ent -

m

e dic

are/

du a

ls

◥

Gui

ded

Car

e (B

oult)

◥

GRA

CE

(Cou

nsel

l)

◥C

are

man

agem

ent P

lus (

dor

r)

◥m

CC

d: B

est P

ract

ice S

ites (

Brow

n)

Com

preh

ensiv

e C

are

man

agem

ent –

m

e dic

aid/

du a

ls

◥

Inte

grat

ed C

are

man

agem

ent

(do u

glas

)

◥C

omm

unity

Bas

ed C

hron

ic C

are

man

agem

ent (

less

ler)

◥

Hos

pita

l to

Hom

e (R

aven

)

◥H

ealth

Car

e m

anag

emen

t Pr

ogra

m (R

econ

nu &

Her

ndon

)

◥

Not

appl

icab

le


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

52Si

cotte

, C., d

’Am

our, d

., & m

orea

ult,

m.P.

(200

2). In

terd

iscip

linar

y C

ollab

orat

ion

with

in Q

uébe

c C

omm

unity

Hea

lth C

are C

entre

s. So

cial

Scien

ce a

nd M

edici

ne, 5

5, 99

1-20

03.

Empi

rica

l Stu

dy P

aper

Stud

ying

inte

rpro

fess

iona

l co

llabo

ratio

n in

Que

bec,

surv

ey o

f CH

CC

’s (C

omm

unity

Hea

lth

Car

e C

entr

es)

CA

NA

dA

- Q

uEB

ECIn

terp

rofe

ssio

nal t

eam

Com

mun

ity H

ealth

Car

e C

entr

es

◥

Serv

ices

pro

vide

d in

a sin

gle l

ocat

ion

◥

vari

ous h

ealth

care

pro

vide

rs

are

pres

ent (

heal

thca

re/s

ocia

l se

rvic

es c

ombi

natio

n)

◥Pr

ofes

siona

ls sh

are

goal

s/re

spon

sibili

ties,

mak

e co

llect

ive

deci

sions

, atte

mpt

to d

istrib

ute

task

s eve

nly

◥

Com

mun

ity-s

pons

ored

gov

erni

ng

stru

ctur

e (u

sual

ly le

d by

a

com

mun

ity b

oard

of d

irect

ors)

◥

CH

CC

s in

Que

bec

wer

e on

ly a

ble

to a

chie

ve m

odes

t re

sults

with

thei

r wid

ely

used

IP

C m

odel

– m

odel

is v

ery

depe

nden

t on

inte

rnal

wok

gr

oup

dyna

mic

s

◥d

espi

te IP

C, p

rofe

ssio

nals

crea

te m

onop

olie

s to

prot

ect

thei

r are

a of

exp

ertis

e

◥Re

-alig

n tr

aini

ng p

rogr

ams t

o fo

ster

stro

nger

colla

bora

tion

betw

een

diffe

rent

gro

ups

in h

ealth

care

53Su

ter,

P., H

enne

ssey

, B., H

arris

on, G

., Fa

gan,

m., N

orm

an, B

., & S

uter

, N.w

. (2

008)

. Hom

e Bas

ed C

hron

ic C

are:

An

Expa

nded

Inte

grat

ive m

odel

for H

ome

Hea

lth P

rofe

ssio

nals.

Hom

e Hea

lth

Care

Nur

se O

nlin

e, 26

(4),

222-

228.

Kno

wle

dge

Synt

hesis

Re

view

The

bene

fits o

f util

izin

g th

e ‘’d

ivisi

on o

f la

bour

’’ in

heal

thca

re

and

the

expa

nsio

n of

th

e tr

aditi

onal

CC

m

(Chr

onic

Car

e m

o del

)

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

Hom

e Ba

sed

Chr

onic

Car

e m

odel

(H

BCC

m)

4 K

ey P

illar

s:

1.

Hig

h To

uch

del

iver

y Sy

stem

(c

ompr

ehen

sive

asse

ssm

ent,

face

-to

-fac

e vi

sits)

2.

Th

eory

-bas

ed se

lf-m

anag

emen

t su

ppor

t (se

lf-effi

cacy

im

prov

emen

t, he

alth

lite

racy

)3.

Spec

ialis

t ove

rsig

ht (c

oach

, gui

de

staff;

liai

se w

ith p

hysic

ian

spec

ialis

ts)4.

T e

chno

logy

(Tel

ehea

lth, E

lect

roni

c Re

gist

ry, d

ata

Exch

ange

)

◥

Posi

tive

– co

st- e

ffect

ive,

bette

r adh

eren

ce

mon

itori

ng, i

mpr

oved

pa

tient

edu

catio

n, e

arlie

r de

tect

ion

and

trea

tmen

t for

de

pres

sion

, pat

ient

s ben

efit

from

hea

lth c

oach

ing

and

self-

mas

tery

tech

niqu

es

54vy

t, A

. (20

08) I

nter

prof

essio

nal

and

tran

sdis

cipl

inar

y te

amw

ork

in

heal

th c

are.

Dia

bete

s Met

ab R

es R

ev,

24(1

), S1

06 –

S10

9. R

etri

eved

from

: w

ww.

inte

rsci

ence

.wile

y.com

(dO

I: 10

.100

2/dm

rr.8

35).

Revi

ew

do

nurs

e-le

d w

alk-

in

cent

res i

mpr

ove

acce

ss

to p

rim

ary

care

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

dia

bete

s Car

e

◥

Shar

ed C

are

Plan

: Pro

mot

es IP

te

amw

ork,

eac

h te

am m

embe

r is

activ

ely

cont

ribut

ing;

eac

h on

e re

spon

sible

for o

ne g

oal w

hile

co

ordi

natin

g sh

ared

car

e of

ca

rryi

ng o

ut re

spon

sibili

ties

◥

Ensu

re th

at th

ere

is an

as

sess

men

t of c

ompe

tenc

ies

◥

use

tech

nolo

gy to

hel

p

with

com

mun

icat

ion


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

55w

exle

r, m

.m., &

Sie

gler

, E.l

. mod

els

of C

are

and

Inte

rpro

fess

iona

l Car

e Re

late

d to

Com

plex

Car

e of

Old

er

Adu

lts. H

artfo

rd In

stitu

te fo

r Ger

iatr

ic

Nur

sing,

1-17

.

des

crip

tive

Pape

r

des

crip

tion

of d

iffer

ent

type

s of g

eria

tric

mod

els

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

Num

erou

s mod

els

Com

plex

Car

e of

Old

er A

dults

com

preh

ensi

ve D

isch

arge

◥

Team

incl

uded

adv

ance

d pr

actic

e nu

rses

, phy

sici

ans,

soci

al w

orke

rs, o

ther

hea

lthca

re

prof

essi

onal

s as n

eede

d;

spec

ializ

ed g

eria

tric

dis

char

ge

coor

dina

ted

by n

urse

spec

ialis

ts

Pac

E M

odel

◥

Com

mun

ity n

urse

s, ph

ysic

ians

, so

cial

wor

kers

pro

vidi

ng so

cial

/m

edic

al se

rvic

es in

an

adul

t day

-ca

re se

tting

; sup

plem

ente

d by

in

-hom

e se

rvic

es

Nur

sing

Hom

e

◥

IP te

am (s

ocia

l wor

kers

, nur

ses,

phys

icia

ns, r

ecre

atio

nal t

hera

pist

s, nu

triti

onist

s) c

reat

e a

co-jo

ined

ca

re p

lan

for c

lient

s

Out

patie

nt g

eria

tric

◥

IP T

eam

(ger

iatr

icia

n, n

urse

s, so

cial

wor

ker,

phys

ical

ther

apist

) st

udyi

ng th

e ph

ysic

al, e

mot

iona

l, ps

ycho

logi

cal a

nd fu

nctio

nal

stat

us o

f the

pat

ient

◥

No

clin

ical

out

com

es

◥Q

uest

ions

nur

ses

shou

ld c

onsid

er b

efor

e cr

eatin

g a

team

: 1.

w

hat a

re th

e iss

ues t

hat

the

team

will

nee

d to

di

scus

s?

2.

who

shou

ld b

e a

mem

ber o

f the

team

an

d w

hy?

3.

How

ofte

n sh

ould

the

team

mee

t?

4.

How

can

you

es

tabl

ish e

ffect

ive

com

mun

icat

ion

and

coop

erat

ion?

5.

w

ho sh

ould

lead

the

com

mitt

ee?

6.

How

shou

ld th

e co

mm

ittee

be

man

aged

?


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

IN

ter

Pro

FeSS

IoN

Al

teA

m m

od

elS

56w

itten

berg

, E., O

liver

, d.P

., d

emir

is, G

., & R

egeh

r, K

. (20

10).

Inte

rdis

cipl

inar

y co

llabo

ratio

n in

ho

spic

e te

am m

eetin

gs. J

ourn

al o

f In

terp

rofe

ssio

nal C

are,

24(3

), 26

4-27

3.

Expl

orat

ory

Stud

y

IP m

embe

rs p

artic

ipat

ed

in a

mod

ified

Inde

x of

Inte

rdis

cipl

inar

y C

olla

bora

tion

(mIC

C) m

easu

ring

th

eir p

erce

ptio

ns o

f co

llabo

ratio

n in

thei

r ho

spic

e te

am

uN

ITEd

ST

ATES

Inte

rpro

fess

iona

l tea

m

(Exp

lora

tory

)

Hos

pice

Car

e

◥

Palli

ativ

e te

am c

are

incl

udes

vo

lunt

eers

, cha

plai

ns, n

urse

s, do

ctor

s, di

etiti

ans,

soci

al w

orke

rs

◥

No

clin

ical

out

com

es

◥R

ole

ambi

guity

in

this

mod

el re

sulte

d in

la

ck o

f col

labo

ratio

n

57Zw

aren

stei

n, m

. , Gol

dman

J., &

Re

eves

, S. (

2009

) Int

erpr

ofes

siona

l co

llabo

ratio

n: eff

ects

of p

ract

ice-

base

d in

terv

entio

ns o

n pr

ofes

siona

l pra

ctic

e an

d he

alth

care

out

com

es. C

ochr

ane

Dat

abas

e of S

yste

mat

ic Re

view

s, 3,

(C

d00

0072

), d

OI:1

0.10

02/1

4651

858.

Cd

0000

72.p

ub2.

Syst

emat

ic R

evie

w

Impa

ct o

f pra

ctic

e ba

sed

inte

rven

tions

that

will

ch

ange

Inte

rpro

fess

iona

l C

olla

bora

tion;

eith

er

by in

crea

sing

patie

nt

satis

fact

ion

or e

ffici

ency

of

hea

lthca

re

GEN

ERA

lIn

terp

rofe

ssio

nal t

eam

*S

tudy

focu

sed

on p

ract

ice

base

d in

terv

entio

ns

◥

Two

stud

ies e

xam

ined

in

terp

rofe

ssio

nal r

ound

s,

◥Tw

o st

udie

s exa

min

ed

inte

rpro

fess

iona

l mee

tings

◥

One

stud

y ex

amin

ed e

xter

nally

fa

cilit

ated

inte

rpro

fess

iona

l aud

it

◥

Revi

ew su

gges

ts th

at p

ract

ice-

base

d IP

C in

terv

entio

ns ca

n im

prov

e hea

lthca

re p

roce

sses

an

d ou

tcom

es

◥va

riou

s: O

ne st

udy

on d

aily

in

terd

isci

plin

ary

roun

ds in

in

patie

nt m

edic

al w

ards

at a

n ac

ute

care

hos

pita

l sho

wed

po

sitiv

e im

pact

on

leng

th

of st

ay a

nd to

tal c

harg

es;

anot

her s

tudy

had

mon

thly

m

ultid

isci

plin

ary

team

m

eetin

gs, w

hich

impr

oved

pr

escr

ibin

g of

psy

chot

ropi

c dr

ugs i

n nu

rsin

g ho

mes


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S1

Alli

nson

, v. (

2003

). Br

east

can

cer:

eval

uatio

n of

a n

urse

-led

fam

ily

hist

ory

clin

ic. J

ourn

al o

f Clin

ical

N

ursin

g, 13

, 765

-766

.

Eval

uativ

e C

ase

Stud

y

Iden

tifyi

ng k

ey c

once

pts

that

mak

e nu

rse-

led

clin

ics a

ccep

tabl

e

uN

ITEd

K

ING

dO

mN

urse

-led

Brea

st C

ance

r

◥

Nur

ses d

iscu

ssin

g fa

mily

hist

ory

of b

reas

t can

cer w

ith p

atie

nts;

brea

st se

lf-ex

ams,

addr

esse

d an

y ot

her f

ears

, que

stio

ns, c

once

rns

◥

Patie

nts e

xpre

ssed

that

they

fe

lt ru

shed

, did

not

hav

e tim

e to

hav

e al

l the

ir qu

estio

ns/

conc

erns

add

ress

ed

◥

mor

e fo

llow

-ups

re

com

men

ded

to b

ridg

e in

form

atio

n ga

p2

Alsa

ffar,

A. (

2005

). Fa

mily

pra

ctic

e:

A n

ursin

g pe

rspe

ctiv

e. O

ntar

io

Fam

ily P

ract

ice,

1-5.

Expl

orat

ory

Stud

y

How

to ra

ise

the

stat

us o

f Fa

mily

Pra

ctic

e N

ursin

g

CA

NA

dA

- O

NTA

RIO

Nur

se-le

d

Fam

ily P

ract

ice

◥

Nur

se a

cts a

s the

firs

t poi

nt o

f co

ntac

t in

the

fam

ily c

are

prac

tice

◥

Nur

se p

rovi

des m

ento

rshi

p to

fa

mily

and

trie

s to

prev

ent f

eelin

gs

of is

olat

ion

of th

e pa

tient

◥

Prov

ides

mor

e cl

inic

al re

sear

ch

to a

ddre

ss th

e kn

owle

dge

gap

◥

In o

rder

to in

crea

se th

e st

atus

of t

he fa

mily

hea

lth

nurs

e, ph

ysic

ians

and

the

publ

ic n

eed

to b

e fu

rthe

r ed

ucat

ed o

n th

e ro

le o

f the

fa

mily

hea

lth n

urse

◥

dev

elop

a se

t cur

ricul

um

in u

nder

grad

uate

pro

gram

s ab

out t

he fa

mily

hea

lth n

urse

3A

rvid

sson

, S.B

., Pet

erss

on, A

., N

ilsso

n, I.

, And

erss

on, B

., Arv

idss

on,

B.S.

, Pet

erss

on, I

.F., &

Fri

dlun

d, B

. (2

006)

. A n

urse

-led

rheu

mat

olog

y cl

inic

’s im

pact

on

empo

wer

ing

patie

nts w

ith rh

eum

atoi

d ar

thrit

is: A

qu

alita

tive s

tudy

. Nur

sing

and

Hea

lth

Scie

nces

, 8, 1

33-1

39.

Qua

litat

ive

Stud

y

Nur

se-le

d rh

eum

atol

ogy

clin

ic e

mpo

wer

ing

patie

nts w

ith th

eir

func

tiona

lity

SwEd

ENN

urse

-led

Rheu

mat

olog

y C

linic

◥

Nur

se fo

cuse

s on

patie

nt

educ

atio

n, c

ouns

ellin

g; d

iscu

sses

tr

eatm

ent o

ptio

ns a

nd h

elps

to

desig

n a

care

pla

n w

ith p

atie

nt

◥

Patie

nts s

atis

fied

with

le

vel o

f car

e pr

ovid

ed in

nu

rse-

led

clin

ic

◥

App

reci

ated

follo

w-u

ps

by n

urse

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S4

Ash

croft

, J., F

arre

lly, B

., Em

man

uel,

E., &

Bor

basi,

S. (

2010

). A

nur

se

prac

titio

ner i

nitia

ted

mod

el o

f se

rvic

e de

liver

y in

car

ing

for p

eopl

e w

ith d

emen

tia. C

onte

mpo

rary

Nur

se,

36(1

-2),

49-6

0.

dis

cuss

ion

Pape

r

Impo

rtan

ce o

f NP

role

in

dem

entia

trea

tmen

t

AuST

RAlI

AN

urse

-led

dem

entia

dem

entia

Out

reac

h Se

rvic

e m

odel

(d

EmO

S)

◥

Team

incl

uded

NP

(lead

), cl

inic

al

nurs

e, cl

inic

al fa

cilit

ator

, end

orse

nu

rse,

assis

tant

in n

ursin

g,

soci

al w

orke

r, re

sear

ch a

ssist

ant,

adm

inist

rativ

e as

sista

nt

◥A

ims:

Impr

ove

qual

ity o

f car

e, re

duce

agg

ress

ion

tow

ards

nur

sing

staff

, bui

ld c

apac

ity, r

educ

e in

appr

opri

ate

refe

rral

s, im

prov

e co

ntin

uity

of c

are

◥

Staff

abl

e to

see

bene

fits

of o

utre

ach

staff

; cap

acity

st

rong

ly im

prov

ed

◥A

ll fa

cilit

ies t

hat t

este

d th

e d

E mO

S m

odel

said

that

th

ey w

ould

use

it a

gain

and

reco

mm

end

dEm

OS

serv

ices

5Ba

rret

t, B.J.

, Gar

g, A

.X., G

oere

e, R.

, le

vin,

A., m

olza

hn, A

. & R

igat

to, C

. (2

011)

. A N

urse

-coo

rdin

ated

mod

el

of C

are v

ersu

s us u

al C

are f

or St

age

3/4

Chr

onic

Kidn

ey d

iseas

e in

the

Com

mun

ity: A

Ran

dom

ized

Con

trolle

d Tr

ial. C

linica

l Jou

rnal

of th

e Am

erica

n So

ciety

of N

ephr

olog

y, 6,

1241

-124

7.

Ran

dom

ized

Con

trol

led

Tria

l

How

to o

ptim

ally

car

e fo

r C

hron

ic K

idne

y d

isea

se

CA

NA

dA

- G

ENER

Al

Nur

se-le

d

Chr

onic

Kid

ney

dis

ease

◥

In th

e in

terv

entio

n gr

oup,

th

e pa

tient

s rec

eive

d ad

ditio

nal

care

, asi

de fr

om th

eir p

hysi

cian

fr

om a

nur

se a

nd n

ephr

olog

ist,

focu

sing

on

lipi

d an

d BP

(blo

od

pres

sure

) man

agem

ent

◥

Patie

nts d

isplay

ed h

igh

satis

fact

ion

with

the l

evel

of

care

in th

e int

erve

ntio

n gr

oup

◥

Bloo

d pr

essu

re le

vels

wer

e lo

wer

ed a

nd m

anag

ed b

ette

r in

the

inte

rven

tion

grou

p

6Be

rra,

K., m

iller

, N.H

., & Je

nnin

gs,

C. (

2011

). N

urse

-bas

ed m

odel

s for

ca

rdio

vasc

ular

dis

ease

pre

vent

ion

from

rese

arch

to c

linic

al p

ract

ice.

Jour

nal o

f Car

diov

ascu

lar N

ursin

g, 26

(45)

, 46-

55.

lite

ratu

re R

evie

w

Exam

inin

g th

e be

nefit

s of

a n

urse

dire

cted

te

am w

ith p

atie

nts w

ith

card

iova

scul

ar d

isea

se

CA

NA

dA

Nur

se-le

d

Car

diov

ascu

lar d

isea

se

◥

Nur

se w

orks

alo

ngsid

e nu

triti

onist

s, ph

ysic

ians

, ph

arm

acist

s, ps

ycho

logi

sts,

soci

al

wor

kers

, alli

ed h

ealth

pro

fess

iona

ls

◥N

urse

focu

ses o

n pa

tient

goa

l-se

tting

and

life

styl

e ch

ange

s

◥

Posit

ive

for p

atie

nts:

Redu

ctio

n in

smok

ing,

bl

ood

pres

sure

leve

ls, b

ette

r di

et c

hoic

es, l

oss o

f wei

ght,

incr

ease

d ph

ysic

al a

ctiv

ity


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S7

Butt,

G. (

2009

). Pa

rtne

rshi

p an

d po

pula

tion

outc

ome

rela

tions

hips

in

four

nur

se-le

d he

patit

is C

inte

grat

ed

prev

entio

n an

d ca

re p

roje

cts.

Thes

is:

mcm

aste

r uni

vers

ity.

Com

para

tive

Stud

y

Exam

inin

g N

urse

-led

proj

ects

in u

rban

and

ru

ral a

reas

in H

epat

itis C

pr

even

tion

and

care

CA

NA

dA

- O

NTA

RIO

Nur

se-le

d

Hep

atiti

s C

◥

This

mod

el fo

cuse

s on

the

syne

rgy

betw

een

nurs

e le

ader

ship

an

d in

terp

rofe

ssio

nal p

ract

ice

and

its o

utco

mes

on

patie

nts i

n nu

rse-

led

Hep

atiti

s C p

reve

ntio

n an

d ca

re p

roje

cts

◥

Two

tool

s wer

e id

entifi

ed

that

pro

ved

to e

ffect

ivel

y m

easu

re g

roup

syne

rgy:

(1

) Par

tner

ship

Sel

f-A

sses

smen

t Too

l par

tner

ship

(P

SAT)

, whi

ch m

easu

res

part

ners

hip

syne

rgy

and

part

ners

hip

func

tioni

ng;

(2) T

eam

Clim

ate

Inve

ntor

y, (T

CI)

whi

ch m

easu

res t

he

inno

vativ

enes

s of t

he te

am8

Car

lucc

i, m.A

., Arg

uello

, l.E

., &

men

on, u

. (20

10).

Eval

uatio

n of

an

adva

nced

pra

ctic

e nur

se- m

anag

ed

diab

etes

clin

ic fo

r vet

eran

s. Th

e Jou

rnal

of

Nur

se P

ract

ition

ers,

6(7)

, 524

-531

.

des

crip

tive

Pilo

t Stu

dy

Psyc

holo

gica

l and

be

havi

oura

l ben

efits

for

vete

rans

in a

n A

dvan

ced

Prac

tice

Nur

ses c

linic

fo

r typ

e 2

diab

etes

uN

ITEd

ST

ATES

Nur

se-le

d

Adv

ance

Pra

ctic

e N

urse

– m

anag

ed

dia

bete

s Clin

ic fo

r vet

eran

s

Adv

ance

d pr

actic

e nu

rse

wor

ks

inde

pend

ently

◥

Patie

nts r

ecei

ve a

que

stio

nnai

re

to a

sses

s phy

siolo

gica

l dat

a;

follo

w-u

p do

ne 6

wee

ks la

ter

◥

Focu

s on

self-

care

and

kn

owle

dge

empo

wer

men

t

◥

Phys

iolo

gica

l cha

nges

w

ere

min

iscu

le

◥

Beha

viou

ral c

hang

es su

ch a

s di

abet

es/in

sulin

adh

eren

ce

incr

ease

d du

e to

APN

ed

ucat

ion

sess

ions

9C

harlt

on, J.

, mac

kay,

l., &

mcK

nigh

t, J.A

. (20

04).

A p

ilot s

tudy

com

parin

g a

type

1 n

urse

-led

diab

etes

clin

ic w

ith a

co

nven

tiona

l doc

tor-

led

diab

etes

clin

ic.

Euro

pean

Dia

bete

s Nur

sing,

1(1)

, 18-

21.

Pilo

t Stu

dy

Eval

uatio

n of

pat

ient

s w

ith d

iabe

tes a

nd th

eir

expe

rien

ce w

ith a

nur

se-

led

clin

ic a

s opp

osed

to

a do

ctor

-led

one

SCO

TlA

Nd

Nur

se-le

d

dia

bete

s

◥

Focu

s on

patie

nt e

duca

tion

and

awar

enes

s; be

havi

oura

l cha

nges

su

ch a

s die

t and

exe

rcisi

ng, g

oal-

setti

ng w

ere

disc

usse

d; ro

utin

es

test

s per

form

ed

◥

95%

of p

atie

nts w

ante

d to

co

ntin

ue w

ith n

urse

-led

care

◥

Shor

ter w

ait t

imes

; bet

ter

cont

inui

ty o

f car

e

◥So

me

issue

s with

ap

poin

tmen

t boo

king

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S10

Chi

u, C

.w., &

won

g, F

.K.Y

. (20

10).

Effec

ts o

f 8 w

eeks

sust

aine

d fo

llow

-up

afte

r a n

urse

con

sulta

tion

on

hype

rten

sion:

a ra

ndom

ised

tria

l. In

tern

atio

nal J

ourn

al o

f Nur

sing

Stud

ies,

47, 1

375-

1382

.

Ran

dom

ized

Con

trol

led

Tria

l

do

patie

nts w

ith H

BP

(Hig

h Bl

ood

Pres

sure

) be

nefit

from

nur

se-le

d cli

nic

telep

hone

follo

w-u

ps?

HO

NG

KO

NG

Nur

se-le

d

Bloo

d pr

essu

re/h

yper

tens

ion

◥

Focu

s on

patie

nts t

o de

crea

se

bloo

d pr

essu

res l

evel

s; nu

rses

pr

ovid

ed e

duca

tion

on d

iet,

exer

cise

, man

agin

g sy

mpt

oms,

and

pres

crip

tion

adhe

renc

e

◥

Follo

w-u

p pa

tient

s inc

reas

ed

heal

thy

lifes

tyle

hab

its

◥Sa

tisfie

d w

ith te

leph

one

follo

w-u

ps

11C

lend

on, J

. (20

01).

The

feas

ibili

ty

of a

nur

se p

ract

ition

er-le

d pr

imar

y he

alth

car

e cl

inic

in a

scho

ol se

tting

: a

com

mun

ity n

eeds

ana

lysis

. Jou

rnal

of

Adv

ance

d N

ursin

g, 34

(2),

171-

178.

Feas

ibili

ty S

tudy

Can

a N

P or

a P

rim

ary

Hea

lth N

urse

take

the

lead

in a

fam

ily c

linic

in

a pr

imar

y sc

hool

?

NEw

ZE

AlA

Nd

Nur

se-le

d

Prim

ary

Car

e

◥

Nur

se p

ract

ition

er w

ould

run

a sc

hool

pri

mar

y ca

re c

linic

; the

nu

rse

wou

ld c

are

for t

he fa

mily

an

d th

e ch

ildre

n

◥

dec

reas

es in

the

num

ber o

f ch

ildre

n ho

spita

lizat

ions

12C

oddi

ngto

n, J.

A., &

San

ds, l

.P.

(200

8). C

ost o

f hea

lth c

are

and

qual

ity o

utco

mes

of p

atie

nts a

t nu

rse-

man

aged

clin

ics.

Nur

sing

Econ

omic

s, 26

(2),

75-8

3.

lite

ratu

re R

evie

w

Cos

t and

qua

lity

of n

urse

m

anag

ed c

linic

s

GEN

ERA

lN

urse

-led

Nur

se w

orks

inde

pend

ently

in c

linic

◥

Focu

s on

beha

viou

ral c

hang

es,

heal

th p

rom

otio

n, im

prov

ing

the

heal

th o

f non

-insu

red

patie

nts

◥

dec

reas

ed h

ospi

taliz

atio

n an

d em

erge

ncy

room

use

◥

Patie

nts e

xtre

mel

y sa

tisfie

d w

ith th

e nu

rse-

man

aged

cl

inic

13C

ollin

s, J.

(201

0). A

udit

of a

nur

se-le

d bo

ne m

arro

w b

iops

y cl

inic

. Can

cer

Nur

sing

Prac

tice,

9(4)

, 14-

19.

Aud

it

Expe

rien

ces o

f pat

ient

s un

derg

oing

bon

e m

arro

w

proc

edur

es b

y a

clin

ic

nurs

e sp

ecia

list

uN

ITEd

K

ING

dO

mN

urse

-led

Trep

hine

Bio

psy,

lym

phom

a

◥

Clin

ical n

urse

spec

ialis

t per

form

s bo

ne m

arro

w as

pira

tion

and

treph

ine

biop

sy in

pat

ients

with

lym

phom

a

◥Th

is is

a ne

w ro

le fo

r C

NS’s

pre

viou

sly d

one

by

seni

or m

edic

al st

aff

◥

Patie

nts e

xper

ienc

ed

min

imum

leve

ls of

pai

n

◥N

urse

was

abl

e to

retr

ieve

hi

gh-q

ualit

y sa

mpl

es

14C

onno

r, C

.C., w

righ

t, C

.C., &

Fe

ga, C

.d. (

2002

). Th

e sa

fety

an

d eff

ectiv

enes

s of n

urse

-led

antic

oagu

lant

serv

ice.

Jour

nal o

f Ad

vanc

ed N

ursin

g, 38

(4),

407-

415.

Com

para

tive

Stud

y

Are

nur

se-le

d an

ticoa

gula

nt c

linic

s as

effe

ctiv

e an

d sa

fe a

s ha

emat

olog

ist le

d cl

inic

s

uN

ITEd

K

ING

dO

mN

urse

-led

Ant

icoa

gula

nt C

linic

s

◥

Nur

se m

anag

es o

ral a

ntic

oagu

lant

th

erap

y an

d m

onito

rs a

nd

man

ages

thei

r IN

R; p

atie

nts a

ttend

cl

inic

from

1-1

0 w

eeks

◥

Ther

e w

ere

no st

atist

ical

ly

signi

fican

t diff

eren

ces

in a

ntic

oagu

lant

con

trol

be

twee

n th

e ha

emat

olog

ist;

nurs

e w

as a

s effe

ctiv

e as

m

anag

ing

the

patie

nts.


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S15

Coo

per C

, whe

eler

, d.m

., w

oolfe

nden

, S., B

oss,

T., &

Pip

er,

S. (2

006)

. Spe

cial

ist h

ome-

base

d nu

rsin

g se

rvic

es fo

r chi

ldre

n w

ith

acut

e an

d ch

roni

c ill

ness

es. C

ochr

ane

Dat

abas

e of S

yste

mat

ic R

evie

w,

4(C

d00

4383

), 1-

22.

Syst

emat

ic R

evie

w

Eval

uatin

g sp

ecia

list

hom

e-ba

sed

nurs

ing

serv

ices

for c

hild

ren

with

ac

ute/

chro

nic

illne

sses

GEN

ERA

lN

urse

-led

Acu

te C

hron

ic Il

lnes

s

◥

Nur

se p

rovi

ding

in-h

ome

visit

s an

d fo

llow

-ups

afte

r dia

gnos

is an

d co

ntin

ued

to p

rovi

de se

rvic

es b

y te

leph

one

for t

he n

ext 2

4 m

onth

s

◥

Impr

oved

satis

fact

ion

w

ith h

ome

care

◥

No

adve

rse

outc

omes

◥

No

evid

ence

of r

educ

ed

acce

ss to

car

e

16C

orse

r, w

., & X

u, Y

. (20

09).

Faci

litat

ing

Patie

nts’

dia

bete

s Se

lf-m

anag

emen

t: A

Pri

mar

y ca

re

Inte

rven

tion

Fram

ewor

k. Jo

urna

l of

Nur

sing

Care

Qua

lity,

24(2

), 17

2-17

8.

Inte

rven

tion

Fram

ewor

k

to su

ppor

t a c

onsis

tent

de

liver

y of

dia

bete

s sel

f-m

anag

emen

t ser

vice

s

GEN

ERA

lN

urse

-led

Self-

man

agem

ent

dia

bete

s Sel

f-m

anag

emen

t (d

S m)

◥

Nur

se c

linic

ians

pla

y a

very

im

port

ant r

ole

in d

Sm;

inte

rven

tion

activ

ities

such

as

tele

phon

e fo

llow

-ups

, dist

ribut

ion

and

expl

anat

ion

of d

Sm w

ritte

n m

ater

ials;

cre

atin

g a

care

pla

n w

ith

the

patie

nt (a

sses

sing

dSm

nee

ds,

reso

urce

s, su

ppor

ts, b

arri

ers)

; pr

ovid

e m

ore

holis

tic c

are

◥

Posit

ive

resu

lts fo

r pat

ient

s:

◥Im

prov

ed d

Sm

beha

viou

rs (n

utrit

ion,

ex

erci

se, s

mok

ing

cess

atio

n)

◥G

reat

er a

cces

sibili

ty to

d

Sm re

sour

ces

◥

Impr

oved

dSm

he

alth

out

com

es

(bet

ter u

nder

stan

ding

of

hea

lth c

ondi

tion,

m

edic

inal

adh

eren

ce)

17C

ox, K

., &

wils

on, E

. (20

03).

Follo

w-u

p fo

r peo

ple

with

can

cer:

nurs

e-le

d se

rvic

es a

nd te

leph

one

inte

rven

tions

. Jou

rnal

of A

dvan

ced

Nur

sing,

43(1

), 51

-61.

lite

ratu

re R

evie

w

The

effec

tiven

ess o

f nu

rse-

led

follo

w-u

ps fo

r ca

ncer

pat

ient

s

GEN

ERA

lN

urse

-led

Can

cer C

are

Follo

w-u

p ca

re, t

elep

hone

inte

rven

tion

◥

Nur

ses p

erfo

rm fo

llow

-ups

with

pa

tient

s via

the p

hone

after

canc

er

trea

tmen

ts, o

r in

pers

on, t

o su

ppor

t th

e pat

ient

’s ps

ycho

logi

cal n

eeds

◥

Satis

fact

ion

of p

atie

nts

with

nur

se-le

d fo

llow

-up

was

hig

h; d

id n

ot im

prov

e qu

ality

of l

ife b

ut m

anag

ing

of sy

mpt

oms

◥

Cos

t-eff

ectiv

e; a

dditi

onal

su

ppor

t pat

ient

s cou

ld

not g

et fr

om th

eir G

Ps

(gen

eral

pra

ctiti

oner

s)


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S18

Cro

we,

C. (

2009

). d

evel

opm

ent

and

impl

emen

tatio

n of

a ‘n

urse

run’

post

-acu

te st

roke

clin

ic. A

ustr

alia

n N

ursin

g Jo

urna

l, 16

(8),

28-3

1.

Cas

e St

udy

ba

sed

on fi

ndin

g

of sy

stem

atic

revi

ew

AuST

RAlI

AN

urse

-led

Stro

ke C

linic

◥

Stro

ke l

iais

on N

urse

(SlN

) co

nnec

t with

the

patie

nt’s

stro

ke

care

pro

vide

r and

gat

hers

all

the

data

bef

ore

the

patie

nt c

omes

to

the

clin

ic; 5

0-m

inut

e ap

poin

tmen

t

◥Sl

N w

orks

alo

ngsid

e st

roke

cl

inic

al n

urse

in th

e sa

me

office

, sh

are

simila

r rol

es

◥N

urse

pro

vide

s edu

catio

n, li

fest

yle/

heal

th p

rom

otio

n, st

ress

test

s, fo

llow

-ups

◥

dec

reas

e in

hos

pita

lizat

ions

◥

dec

reas

e in

ca

re fr

agm

enta

tion

19C

ruic

ksha

nk, S

., Ken

nedy

C.,

lock

hart

, K., d

osse

r, I.,

& d

alla

s, l.

(2

008)

. Spe

cial

ist b

reas

t car

e nur

ses

for s

uppo

rtiv

e car

e of w

omen

with

br

east

canc

er. C

ochr

ane D

atab

ase o

f Sy

stem

atic

Revi

ews,

1(C

d00

5634

), 1-

40.

Syst

emat

ic R

evie

w

Esta

blish

ing

chan

ges i

n ou

tcom

e fo

r pat

ient

s with

br

east

can

cer t

hrou

gh

Brea

st C

ance

r Nur

ses

GEN

ERA

lN

urse

-led

Brea

st C

ance

r

◥

Nur

se sp

ecia

list s

ees p

atie

nts 3

m

onth

s pos

t-su

rger

y; p

rovi

des

info

rmat

ion

on re

curr

ence

, ad

vice

, con

tact

det

ails,

add

ress

ing

sym

ptom

con

cern

s

◥C

oord

inat

ed y

early

mam

mog

ram

◥

Bres

t can

cer n

urse

s pro

vide

so

me

bene

fit to

pat

ient

s ar

eas s

uch

as a

nxie

ty, e

arly

re

cogn

ition

dep

ress

ive

sym

ptom

s

◥N

o sig

nific

ant fi

ndin

gs

20d

esbo

roug

h, J.

, For

rest

, l., &

Par

ker,

R. (2

011)

. Nur

se-le

d pr

imar

y he

alth

care

wal

k-in

cen

tres

: an

inte

grat

ive

liter

atur

e re

view

. Jou

rnal

of

Adv

ance

d N

ursin

g, 68

(2),

248-

263.

Inte

grat

ive

lite

ratu

re

Revi

ew

Are

wal

k-in

cen

tres

by

nurs

es a

nd e

ffect

ive

way

to

impr

ove

acce

ss to

pr

imar

y ca

re

GEN

ERA

lN

urse

-led

Prim

ary

Hea

lthca

re w

alk-

in C

entr

es

◥

Nur

ses p

rovi

ding

care

for a

var

iety

of

illn

esse

s, sh

orte

r wai

t tim

es, m

ore

focu

s on

sym

ptom

man

agem

ent

◥

Incr

ease

d de

man

d fo

r w

alk-

in c

linic

s; nu

rsin

g ed

ucat

ion

need

s to

mat

ch

the

dem

and

for t

his


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S21

Edw

ards

, J.B

., Opp

ewal

, S., &

log

an,

C. l

. (20

03).

Nur

se-m

anag

ed

Prim

ary

Car

e: O

utco

mes

of a

Fa

culty

Pra

ctic

e N

etw

ork.

Jour

nal

of th

e Am

eric

an A

cade

my

of N

urse

Pr

actit

ione

rs, 1

5(12

), 56

3-56

9.

Prog

ram

Eva

luat

ion

Eval

uatin

g N

urse

m

anag

ed C

are

at a

Fa

culty

Pra

ctic

e N

etw

ork

uN

ITEd

ST

ATES

Nur

se-le

d

Acu

te C

hron

ic Il

lnes

s

◥

Staffi

ng v

arie

s: re

gist

ered

nur

se,

prac

tice

nurs

es, c

ase

man

ager

s, he

alth

edu

cato

rs, o

vers

een

by

a ph

ysic

ian

men

tor

◥

Focu

s on

prev

entiv

e an

d he

alth

pr

omot

ion

serv

ices

for c

lient

s

◥

Patie

nt sa

tisfa

ctio

n ra

te is

ve

ry h

igh,

(91%

) and

94%

sa

id th

at th

ey w

ould

retu

rn

for f

urth

er c

are;

exte

rnal

and

in

tern

al a

udits

find

qua

lity

of c

are

to b

e ex

celle

nt;

stud

ents

stud

y at

the

cent

res

and

facu

lty m

embe

rs p

rese

nt

rese

arch

bas

ed o

n th

eir

wor

k w

ith th

e FP

N (F

amily

Pr

actic

e N

etw

ork)

22Fa

rrel

l, C

., mol

assio

tis, A

., Bea

ver,

K.,

& H

eave

n, C

. (20

11).

Expl

orin

g th

e sc

ope

of o

ncol

ogy

spec

ialis

t nur

ses’

prac

tice

in th

e u

K. E

urop

ean

Jour

nal

of O

ncol

ogy

Nur

sing,

15, 1

60-1

66.

Surv

ey

Expl

orin

g th

e

scop

e of

pra

ctic

e of

nu

rses

in o

ncol

ogy

by

surv

eyin

g nu

rses

uN

ITEd

K

ING

dO

mN

urse

-led

Onc

olog

y

◥

Nur

se-le

d cli

nics

that

pro

vide

pa

tient

s with

scre

enin

g, as

sess

men

ts,

follo

w-u

ps, e

duca

tion,

coun

selli

ng

◥Ro

le e

xpan

sion

nece

ssar

y du

e to

ga

ps in

the

heal

thca

re sy

stem

◥

Nur

ses e

xper

ienc

ing

barr

iers

such

as

lack

of s

uppo

rt fo

r aut

onom

ous

nurs

e-le

d cl

inic

s; ca

nnot

pre

scrib

e ch

emot

hera

py d

rugs

on

thei

r ow

n

◥

Nur

se-le

d cl

inic

s tre

at

patie

nts h

olist

ical

ly a

nd

redu

ce w

ait t

imes

and

ho

spita

l visi

ts

◥Ro

le cla

rity

and

scop

e of n

urse

du

ties s

houl

d be

clar

ified

to

enha

nce c

olla

bora

tion

◥

mor

e su

ppor

t pro

vide

d

by p

hysic

ians

23Fe

lber

, d., m

aham

a, N

., moh

ar, d

.R.H

., &

Kin

ion,

E. (

2003

). N

ursin

g ca

re

deliv

ered

at ac

adem

ic co

mm

unity

-ba

sed

nurs

e-m

anag

ed ce

nter

. Out

com

es

man

agem

ent,

7(2)

, 84-

89.

Retr

ospe

ctiv

e d

escr

iptiv

e St

udy

Serv

ices

del

iver

ed b

y C

omm

unity

-bas

ed N

urse

m

anag

ed C

entr

es

uN

ITEd

ST

ATES

Nur

se-le

d

Hea

lth P

rom

otio

n/d

isea

se P

reve

ntio

n

◥

Nur

se w

orks

alo

ngsi

de n

ursi

ng

stud

ents

, med

ical

stud

ents

, vo

lunt

eers

phy

sici

ans,

3r

d ye

ar re

side

nts

◥

Com

mun

ity N

urse

-man

aged

C

ente

r (C

Nm

C) w

orks

with

the

unde

rser

ved;

stro

ng fo

cus o

n he

alth

pr

omot

ion,

dise

ase p

reve

ntio

n

◥

No

clin

ical

out

com

es

◥C

Nm

C m

ain

goal

is to

im

prov

e ac

cess

to c

are;

colla

bora

tion

with

oth

er

soci

al a

genc

ies b

ring

s mor

e at

tent

ion

to th

is iss

ue fo

r po

licy

chan

ge


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S24

Fitz

simm

ons,

d., H

awke

r, S.

E.,

Geo

rge,

S.l.

, Joh

nson

, C.d

., &

Cor

ner,

J.l. (

2005

). N

urse

-led

mod

els o

f che

mot

hera

py c

are:

mix

ed e

cono

my

or n

urse

-doc

tor

subs

titut

ion?

Jour

nal o

f Adv

ance

d N

ursin

g, 50

(3) 2

44-2

52.

Expl

orat

ory

Stud

y

How

do

canc

er se

rvic

e us

ers f

eel a

bout

nur

se-le

d ch

emot

hera

py c

linic

s

uN

ITEd

K

ING

dO

mN

urse

-led

Che

mot

hera

py C

are

◥

Nur

se w

ould

be r

espo

nsib

le fo

r tot

al

patie

nt m

anag

emen

t (as

sess

men

t, pr

escr

ibin

g ch

emo

dose

s, pr

escr

ibin

g sy

mpt

om re

late

d dr

ugs,

adm

inist

erin

g th

e che

mot

hera

py,

orde

ring

bloo

d w

ork)

◥

Pote

ntia

l to

redu

ce w

ait

times

; les

s str

ess o

n m

edic

al

staff

; cos

t- sa

ving

mea

sure

25Fo

rem

an, d

.m., &

mor

ton,

S.

(201

1). N

urse

-del

iver

ed a

nd d

octo

r-de

liver

ed c

are

in a

n at

tent

ion

defic

it hy

pera

ctiv

ity d

isor

der f

ollo

w-u

p cl

inic

: a c

ompa

rativ

e st

udy

usin

g pr

open

sity

scor

e m

atch

ing.

Jour

nal o

f Ad

vanc

ed N

ursin

g, 67

(6),

1341

-134

8.

Com

para

tive

Stud

y

Are

nur

se p

resc

riber

s as

effe

ctiv

e as

doc

tors

in

Atte

ntio

n d

efici

t H

yper

activ

e d

isor

der

uN

ITEd

K

ING

dO

mN

urse

-led

Atte

ntio

n d

e fici

t Hyp

erac

tivity

d

isor

der (

Ad

Hd

)

◥

Nur

se-le

d A

dH

d c

linic

; the

nu

rse

wou

ld in

depe

nden

tly

diag

nose

rout

ine

case

s of A

dH

d,

man

age

thes

e pa

tient

s and

di

spen

se th

eir m

edic

atio

n.

◥Th

e nu

rse

was

to b

e qu

alifi

ed

as a

gen

eral

and

men

tal h

ealth

nu

rse,

and

obta

ined

a n

urse

pr

escr

ibin

g qu

alifi

catio

n

◥

Pote

ntia

lly c

ost-

savi

ng

◥Re

duce

s stig

mas

abo

ut

nurs

e’s sc

ope

of w

ork

26G

iven

, C. w

., Giv

en, B

.A., S

ikor

skii,

A

., You

, m., S

angc

hoon

, J., C

ham

pion

, v.

, & m

cCor

kle,

R. (2

010)

. d

econ

stru

ctio

n of

Nur

se-d

eliv

ered

Pa

tient

Sel

f-m

anag

emen

t: Fa

ctor

s Re

late

d to

del

iver

y En

actm

ent a

nd

Resp

onse

. Ann

Beh

avio

ral M

ed,

40(1

), 99

-113

.

Ran

dom

ized

Clin

ical

Tr

ial S

tudy

Self-

man

agem

ent

inte

rven

tions

rela

ted

to sy

mpt

om re

spon

ses

amon

gst c

ance

r pat

ient

s

uN

ITEd

ST

ATES

Nur

se-le

d

Prim

ary

Car

e - d

epre

ssio

n

◥

Nur

ses g

uide

d pa

tient

s thr

ough

fo

ur st

ages

; sel

f-ca

re b

ehav

iour

s, in

form

atio

n an

d de

cisio

n-m

akin

g,

com

mun

icat

ion

with

fam

ily/

prov

ider

s

◥N

urse

s use

softw

are

to a

sses

s an

d ra

te sy

mpt

oms,

reco

rd

inte

rven

tions

that

the

patie

nts h

ad

trie

d/w

ere

curr

ently

usin

g

◥

Allo

wed

pat

ient

s to

be m

ore

enga

ged

in se

lf-ca

re

◥Pa

tient

s pri

oriti

ze p

robl

ems

usin

g m

etho

ds th

at fi

t int

o th

eir r

outin

es


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S27

Glyn

n, lG

., mur

phy, A

.w., S

mith

, S.m

., Sch

roed

er, K

., Fah

ey, T

. (201

0).

Inter

vent

ions

use

d to

impr

ove c

ontro

l of

bloo

d pr

essu

re in

pati

ents

with

hy

perte

nsio

n. Co

chra

ne D

atab

ase o

f Sy

stem

atic

Revie

ws, 3

(Cd

0051

82),

dO

I:10.1

002/

1465

1858

. Cd

0051

82.p

ub4.

Syst

emat

ic R

evie

w

Effec

tiven

ess o

f in

terv

entio

ns to

impr

ove

bloo

d pr

essu

re co

ntro

l in

patie

nts w

ith h

yper

tens

ion

GEN

ERA

lN

urse

or P

harm

acy

led

Car

e

◥

Nur

se-le

d in

terv

entio

ns in

clude

d ph

one c

all s

uppo

rts,

appo

intm

ent

follo

w-u

p re

min

ders

, tea

chin

g pa

tient

self-

mon

itorin

g te

chni

ques

, m

onito

ring

and

trac

king

of

hype

rten

sion

patie

nts`

pro

gres

s

◥

Posit

ive:

dem

onst

rate

d bl

ood

pres

sure

con

trol

, st

abili

zatio

n of

mea

n sy

stol

ic

bloo

d pr

essu

re, a

dher

ence

to

follo

w-u

ps b

y pa

tient

s

◥Ed

ucat

ion

alon

e is

no

t effe

ctiv

e

28G

raha

m, l

., Nea

l, C.P.

, Gar

cea,

G.,

lloy

d, d

. m., R

ober

tson

, G.S

. & S

utto

n,

C.d

. (20

10).

Eval

uatio

n of

nur

se-le

d di

scha

rge f

ollo

win

g la

paro

scop

ic

surg

ery.

Jour

nal o

f Eva

luat

ion

in

Clin

ical P

ract

ice, 1

8, 1

9-24

.

Retr

ospe

ctiv

e C

ompa

riso

n

Ass

essi

ng th

e eff

ectiv

enes

s of a

nur

se-

led

disc

harg

e fo

llow

ing

lapa

rosc

opic

surg

ery

uN

ITEd

K

ING

dO

mN

urse

-led

lapa

rosc

opic

Sur

gery

◥

Nur

ses h

ave

a ve

ry c

lear

out

line

on d

isch

arge

that

they

mus

t fo

llow

resu

lting

in m

ore

nurs

e-le

d di

scha

rges

◥

Nur

se-le

d di

scha

rges

shou

ld

be e

ncou

rage

d; re

duce

w

orkl

oad

of th

e ph

ysic

ians

◥

Re-a

rran

ge sc

hedu

ling

of

patie

nts s

o di

scha

rges

can

oc

cur a

t opt

imal

tim

es,

incr

easin

g be

d av

aila

bilit

y29

Hab

er, J

., Str

asse

r, S.

, llo

yd, m

., d

orse

n, C

., Kna

pp, R

., & A

uerh

ahn,

C

. (20

09).

The

oral

-sys

tem

ic

conn

ectio

n in

pri

mar

y ca

re. N

urse

Pr

actit

ione

r, 34

(3),

43-4

8.

Ove

rvie

w

Exam

ples

of n

urse

-m

anag

ed h

ealth

cen

tres

uN

ITEd

ST

ATES

Nur

se-le

d

Can

cer,

Chr

onic

dis

ease

man

agem

ent

◥

Nur

ses p

rovi

ded

com

preh

ensiv

e he

alth

and

risk

ass

essm

ents

; ca

ncer

scre

enin

g, h

ealth

ed

ucat

ion/

coun

selli

ng,

man

agem

ent o

f chr

onic

co

nditi

ons;

diag

nosis

/tre

atm

ent

of a

cute

illn

esse

s

◥

Hig

h ra

tes o

f pat

ient

sa

tisfa

ctio

n; 9

5% a

gree

d to

re

com

men

d ca

re se

rvic

es

they

rece

ived


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S30

Har

ris,

d.l

., &

Cra

ckne

ll, P

. (20

05)

Impr

ovin

g di

abet

es c

are

in g

ener

al

prac

tice

usin

g a

nurs

e-le

d, G

P su

ppor

ted

clin

ic: a

coh

ort s

tudy

. Pr

actic

al D

iabe

tes I

nter

natio

nal,

22(8

) 295

-300

.

Coh

ort S

tudy

Stud

ying

pat

ient

cent

red

care

met

hods

surr

ound

ing

type

2 d

iabe

tes

uN

ITEd

K

ING

dO

mN

urse

-led

dia

bete

s Car

e

◥

Nur

ses u

nder

wen

t ext

ra tr

aini

ng

in d

iabe

tes c

are

man

agem

ent

◥

Nur

se c

reat

ed a

man

agem

ent p

lan

for e

ach

patie

nt th

at w

as v

erifi

ed

by th

e G

P (G

ener

al P

ract

ition

er)

◥

Nur

se d

iscu

ssed

fitn

ess/

heal

th

goal

s at a

ppoi

ntm

ents

◥

If n

eede

d, p

resc

riptio

ns w

ere

chan

ged/

alte

red

◥

The

nurs

e-le

d cl

inic

co

uld

prov

ide

patie

nts

with

the

inte

nsiv

e fo

llow

- up

they

nee

ded

that

the

G

P cl

inic

cou

ldn’

t due

to

tim

e co

nstr

aint

s

◥N

urse

-led

clin

ic im

prov

ed

chol

este

rol a

nd b

lood

gl

ucos

e le

vels

in p

atie

nts

31H

eale

, R., &

But

cher

, m. (

2010

). C

anad

a`s F

irst N

urse

Pra

ctiti

oner

le

d C

linic

: A C

ase

Stud

y in

H

ealth

care

Inno

vatio

n. N

ursin

g Le

ader

ship

, 23(

3), 2

1-29

.

Cas

e St

udy

CA

NA

dA

- O

NTA

RIO

Nur

se-le

d

Nor

ther

n O

ntar

io –

est

ablis

hmen

t of

first

NP-

led

clin

ic

◥

Ant

eced

ents

for s

ucce

ss: l

eade

rshi

p,

finan

cial

cons

ider

atio

ns, id

ea

gene

ratio

n, te

amw

ork,

cultu

re

(cul

tivat

ing

acce

ptan

ce, u

se o

f m

edia

and

dem

and

for c

are a

nd fo

r jo

bs fo

r NPs

)

◥A

dvoc

acy

wor

k hi

ghlig

hted

◥

Barr

iers

: com

plex

care

nee

ds;

resis

tanc

e fro

m o

rgan

ized

med

icin

e

◥m

odel

cha

ract

erist

ics:

boar

d

with

51%

NPs

on

boar

d –

cann

ot b

e em

ploy

ees,

NP

for

clin

ic d

irect

or, s

alar

ied

staff

, ph

ysic

ians

as c

onsu

ltant

s, di

etiti

an,

phar

mac

ist, r

egist

ered

nur

ses,

cler

ical

; sat

ellit

e sit

e(s)

◥

Not

app

licab

le


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S32

Heb

ert,

P.l.

, Sisk

, J.E

., wan

t, J.J

., Tu

zzlo

, l., C

asab

lanc

a, J.m

., Cha

ssin

, m

.R., H

orow

its, C

., & m

clau

ghlin

, m

.A. (

2008

). C

ost-

effec

tiven

ess o

f nu

rse-

led

dise

ase

man

agem

ent f

or

hear

t fai

lure

in a

n et

hnic

ally

div

erse

ur

ban

com

mun

ity. A

nnal

s of I

nter

nal

Med

icin

e, 14

9(8)

, 540

-548

.

Ran

dom

ized

Con

trol

led

Tria

l

Can

nur

se-le

d he

art

failu

re c

linic

s red

uce

cost

an

d im

prov

e qu

ality

of l

ife

uN

ITEd

ST

ATES

Nur

se-le

d

Car

diov

ascu

lar d

isea

se

◥

Nur

se a

ssig

ned

203

patie

nts;

incl

uded

1 in

-per

son

appo

intm

ent

and

peri

odic

follo

w-u

ps b

y ph

one

over

12

mon

ths

◥

Patie

nts e

xpre

ssed

im

prov

emen

ts in

qua

lity

of li

fe

◥C

ost-

effec

tiven

ess

impr

oved

slig

htly

33H

ilton

, B.A

., Bud

gen,

C., m

o lza

hn, A

., &

Attr

idge

, C.B

. (20

01).

de v

elop

ing

and

Test

ing

Inst

rum

ents

to m

easu

re

Clie

nt O

utco

mes

at t

he C

omox

va

lley

Nur

sing

Cen

tre.

Publ

ic H

ealth

N

ursin

g, 18

(5),

327-

339.

Pilo

t Stu

dy w

ith m

ulti-

met

hod

Eval

uatio

n

Prog

ram

Eva

luat

ion

of

16 m

onth

dem

onst

ratio

n pr

ojec

t – su

rvey

and

qu

alita

tive

inte

rvie

ws

with

clie

nts

CA

NA

dA

- BR

ITIS

H

CO

lum

B IA

Nur

se-le

d

Prim

ary

care

Free

-sta

ndin

g nu

rse-

man

aged

cen

tre

offer

ing

drop

-ins,

grou

p an

d ou

trea

ch

serv

ices

in a

smal

l com

mun

ity o

f 58

,000

peo

ple.

Cen

tre

staff

ed b

y nu

rsin

g co

ordi

nato

r, 4

part

-tim

e nu

rses

an

d ha

lf- ti

me

secr

etar

y/re

cept

ioni

st.

Focu

sed

on:

◥

coor

dina

tion

and

inte

grat

ion

of

hea

lthca

re se

rvic

es

◥pr

ovid

e es

sent

ial h

ealth

care

in

the

com

mun

ity

◥in

crea

se c

lient

/pat

ient

self-

relia

nce

◥

focu

s on

stra

tegi

es to

redu

ce

the

effec

ts o

f soc

ial d

eter

min

ants

of

hea

lth

◥pr

ovid

e nu

rsin

g ca

re th

at is

eff

ectiv

e (in

term

s of c

ost a

nd

heal

th b

enefi

ts)

◥

Hig

h cl

ient

satis

fact

ion

◥

mor

e kn

owle

dgea

ble

abou

t he

alth

situ

atio

n

◥Im

prov

ed p

hysic

ally

an

d m

enta

lly

◥Pa

tient

s tak

ing

actio

n on

th

eir o

wn

beha

lf

◥Be

tter u

se o

f hea

lthca

re

reso

urce

s (i.e

. not

usin

g

the

hosp

ital e

mer

genc

y ro

om a

s muc

h)

◥C

an c

omm

unic

ate

m

ore

effec

tivel

y w

ith

heal

thca

re p

rovi

ders

◥

Hel

ping

oth

ers t

hrou

gh

com

mun

ity a

ctio

n an

d gr

oup

supp

ort


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S34

Ism

ail,

N., R

atch

ford

, I., P

roud

foot

, C

., & G

ibbs

, J. (

2011

). Im

pact

of

a n

urse

-led

clin

ic fo

r chr

onic

co

nstip

atio

n in

chi

ldre

n. Jo

urna

l of

Child

Hea

lth C

are,

15(3

), 22

1-22

9.

Eval

uativ

e St

udy

Impa

ct o

f out

patie

nt

nurs

es m

anag

ing

child

ren

with

chr

onic

con

stip

atio

n us

ing

a qu

estio

nnai

re

uN

ITEd

K

ING

dO

mN

urse

-led

Chr

onic

Con

stip

atio

n

◥

Nur

se e

duca

tes p

atie

nts/

child

ren

abou

t the

con

ditio

n

◥Es

tabl

ish a

goo

d to

iletr

y ro

utin

e

◥Pr

ovid

ed li

tera

ture

on

ca

re m

anag

emen

t

◥Pr

ovid

e su

ppor

t/fol

low

-up

appo

intm

ents

◥

Redu

ctio

n in

def

ecat

ion

pain

◥

Chi

ldre

n m

ore

will

ing

to

use

the

toile

t

◥Pa

rent

kno

wle

dge

of th

e co

nditi

on in

crea

sed

◥

Satis

fact

ion

with

nur

se-le

d cl

inic

incr

ease

d fr

om 3

4-90

%

35K

ovne

r, C

., & w

alan

i, S.

(201

0). N

urse

m

anag

ed H

ealth

Cen

ters

(Nm

HC

s)

- Res

earc

h Br

ief.

Robe

rt W

ood

John

son

Foun

datio

n N

ursin

g Re

sear

ch

Net

wor

k, 1

-2. R

etri

eved

from

: ht

tp://

ww

w.rw

jf.or

g.

Rese

arch

Bri

ef

des

crib

ing

Nur

se

man

aged

Cen

tres

as a

so

urce

of P

rim

ary

care

uN

ITEd

ST

ATES

Nur

se-le

d

Prim

ary

Car

e

◥

mod

el: N

urse

-man

aged

hea

lth

cent

res (

Nm

HC

); us

ually

und

er

the

lead

ersh

ip o

f an

adva

nced

pr

actic

e nu

rse;

emph

asis

on h

ealth

ed

ucat

ion,

pre

vent

ion,

an

d pr

omot

ion;

◥u

sual

ly p

rovi

de c

are

to

unde

rser

ved

com

mun

ities

◥

Som

e evi

denc

e tha

t if N

mH

Cs

oper

ated

at fu

ll ca

pacit

y, th

e co

st of

care

per

visit

wou

ld

decr

ease

; less

expe

nsiv

e tha

n lo

cal m

edica

l car

e

◥So

me

evid

ence

that

Nm

HC

s pr

escr

ibe

high

er ra

tes o

f ge

neri

c m

edic

atio

n


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S36

laur

ant,

m., R

eeve

s, d

., Her

men

s, R.

, Br

aspe

nnin

g, J.

, Gro

l, R.

, & S

ibba

ld,

B. (R

epri

nted

200

9). S

ubst

itutio

n of

do

ctor

s by

nurs

es in

pri

mar

y ca

re.

Coch

rane

Dat

abas

e of S

yste

mat

ic

Revi

ews 2

004,

4(C

d00

127)

, dO

I: 10

.100

2/14

6518

58.C

d00

1271

.pub

2.

Syst

emat

ic R

evie

w

dem

and

for p

rim

ary

care

se

rvic

es h

as in

crea

sed

and

supp

ly o

f phy

sicia

ns

is co

nstr

aine

d –

resu

lt is

nurs

e-do

ctor

subs

titut

ion

GEN

ERA

l N

urse

-led

Car

e

doc

tor-

nurs

e su

bstit

utio

n

◥

In 7

stud

ies t

he n

urse

as

sum

ed re

spon

sibili

ty fo

r firs

t co

ntac

t and

ong

oing

car

e fo

r all

pres

entin

g pa

tient

s (m

ixed

resu

lts,

som

e po

sitiv

e)

◥In

5 st

udie

s the

nur

se a

ssum

ed

resp

onsib

ility

for fi

rst c

onta

ct

care

for p

atie

nts w

antin

g ur

gent

co

nsul

tatio

ns d

urin

g offi

ce

hour

s or o

ut-o

f-ho

urs (

patie

nts

mor

e sa

tisfie

d w

ith n

urse

-led

cons

ulta

tions

/car

e)

◥In

4 st

udie

s, nu

rse

took

re

spon

sibili

ty fo

r the

ong

oing

m

anag

emen

t of p

atie

nts w

ith

part

icul

ar c

hron

ic c

ondi

tions

(no

signi

fican

t diff

eren

ces)

◥

Find

ings

sugg

est t

hat

appr

opri

atel

y tr

aine

d nu

rses

ca

n pr

oduc

e as

hig

h qu

ality

ca

re a

s pri

mar

y ca

re d

octo

rs

and

achi

eve

as g

ood

◥

heal

th o

utco

mes

for p

atie

nts

(mor

e st

udie

s req

uire

d)

◥N

urse

s hav

e th

e po

tent

ial

to re

duce

doc

tor w

orkl

oads

an

d he

alth

care

cos

ts b

ased

on

con

text

37le

wis,

R., N

eal,

R.d

., will

iam

s, N

.H.,

Fran

ce, B

., & w

ilkin

son,

C. (

2009

) N

urse

-led

vs. c

onve

ntio

nal p

hysic

ian-

led

follo

w-u

p fo

r pat

ient

s with

ca

ncer

: sys

tem

atic

revi

ew. J

ourn

al o

f Ad

vanc

ed N

ursin

g, 65

(4),

706–

723.

Syst

emat

ic R

evie

w

Revi

ew o

f effe

ctiv

enes

s an

d co

st e

ffect

iven

ess o

f nu

rse-

led

follo

w u

p fo

r pa

tient

s with

can

cer

GEN

ERA

lN

urse

-led

Can

cer C

are

◥

The

role

of t

he sp

ecia

list n

urse

w

as to

pro

vide

info

rmat

ion

and

supp

ort,

co-o

rdin

ate

inpu

t fro

m

othe

r age

ncie

s or s

ervi

ces,

and

faci

litat

e co

mm

unic

atio

n w

ith G

Ps

and

prim

ary

heal

thca

re te

ams

◥

Cos

t-effi

cien

t, fe

asib

le

◥

Patie

nts p

refe

rred

the

conv

enie

nce

of n

urse

- le

d fo

llow

-ups

by

phon

e

but e

njoy

in p

erso

n fo

llow

-up

s ove

rall


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S38

lyon

, S. (

2011

). Sm

all,

Inde

pend

ent,

and

Out

in F

ront

. Sto

ries

from

the

field

, Nur

se-le

d M

edic

al H

omes

: In

crea

sing A

cces

s to

Qua

lity

Care

, A

pril,

1-2

.

Cas

e St

udy

Exam

inin

g th

e fir

st n

urse

-le

d pr

actic

e in

the

u.S

. to

rece

ive

leve

l 3 P

atie

nt

Cen

tred

med

ical

hom

e re

cogn

ition

from

the

Nat

iona

l Com

mitt

ee fo

r Q

ualit

y A

ssur

ance

uN

ITEd

ST

ATES

Nur

se-le

d

Chr

onic

dis

ease

man

agem

ent

◥

Faci

lity

whe

re a

dvan

ced

prac

tice

regi

ster

ed n

urse

s hav

e th

e au

tono

my

to p

ract

ice

with

out

phys

icia

n ov

ersig

ht

◥u

se o

f Em

Rs, e

lect

roni

c pr

escr

ibin

g, re

gist

ries

for c

hron

ic

dise

ase

patie

nts

◥

Adv

ance

d pr

actic

e

regi

ster

ed n

urse

s can

del

iver

th

e sa

me

qual

ity o

f car

e as

fa

mily

pra

ctiti

oner

s

◥Pa

tient

s fee

l com

fort

able

in

thei

r hea

lthca

re en

viro

nmen

t; pr

ovid

ed w

ith ed

ucat

ion

and

coun

selli

ng to

take

ow

ners

hip

of th

eir h

ealth

39m

a rtin

-mi s

ener

, R., R

eilly

, S.m

., &

vol

lman

, A.R

. (20

10).

defi

ning

th

e ro

le o

f pri

mar

y he

alth

car

e nu

rse

prac

titio

ners

in ru

ral N

ova

Scot

ia. C

anad

ian

Jour

nal o

f Nur

sing

Rese

arch

, 42(

2), 3

0-47

.

mix

ed m

etho

ds S

tudy

Exam

inin

g th

e in

fluen

tial

fact

ors f

or th

e fu

ll in

tegr

atio

n of

NP`

s in

to p

rim

ary

and

acut

e ca

re (l

egis

lativ

e, ed

ucat

iona

l, pr

actic

e)

CA

NA

dA

- N

OvA

SC

OTI

AN

urse

-led

Prim

ary

Hea

lthca

re

◥

9 C

hair

pers

ons –

6 fe

mal

e an

d

3 m

ale

– w

ere

inte

rvie

wed

◥

In ru

ral N

ova

Scot

ia, w

ait t

imes

to

acc

ess a

fam

ily p

ract

ice i

s 3-4

w

eeks

, so

man

y pe

ople

go

to th

e ER

◥

Expa

nd ro

le o

f the

NP

and

enco

urag

e nu

rse-

led

prac

tices

in

orde

r to

perf

orm

mor

e pr

oced

ures

, pr

escr

ibe

mor

e m

edic

atio

ns, a

nd

adm

it pa

tient

s whe

n ne

cess

ary

◥

The

NPs

are

the

link

betw

een

the

com

mun

ity a

nd fa

mily

pra

ctic

e an

d th

eir r

ole

is to

pro

vide

ou

trea

ch se

rvic

es

◥

Find

ings

sugg

est t

hat

nurs

e pra

ctiti

oner

s are

not

be

ing

enco

urag

ed o

r giv

en

oppo

rtun

ities

to w

ork

to th

eir

full

pote

ntia

l; ba

rrie

rs in

thei

r pr

actic

e nee

d to

be r

emov

ed

◥Th

is ca

n be

acc

ompl

ished

by

educ

atin

g th

e co

mm

unity

on

the

role

of t

he n

urse

pr

actit

ione

r and

incr

easin

g pa

tient

acc

ess t

o nu

rse

prac

titio

ners


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S40

mcA

iney

, C.A

., Hau

ghto

n, d

., Je

nnin

gs, J

., Far

r, d

., Hill

ier,

l., &

m

orde

n, P

. (20

08).

A u

niqu

e pr

actic

e m

odel

for n

urse

pra

ctiti

oner

s in

long

-ter

m c

are

hom

es. J

ourn

al o

f Ad

vanc

ed N

ursin

g, 62

(5),

562-

571.

Pilo

t Pro

ject

Can

NPs

incr

ease

staff

co

nfide

nce,

prev

ent

hosp

ital a

dmiss

ion

and

prom

ote

early

dis

char

ge

CA

NA

dA

- O

NTA

RIO

Nur

se-le

d

Ger

onto

logy

◥

NP

wou

ld p

rovi

de a

sses

smen

t and

tr

eatm

ent f

or c

omm

on c

ompl

ex

cond

ition

s; ra

pid

care

◥

Prev

ent u

nnec

essa

ry

hosp

italiz

atio

ns a

nd p

rom

ote

ea

rly d

isch

arge

s

◥In

crea

se st

aff c

apac

ity to

del

iver

op

timal

car

e

◥N

P w

ould

wor

k al

ongs

ide

phys

icia

ns an

d ot

her s

taff

mem

bers

◥

In th

e st

udy,

nurs

es p

rosp

ectiv

ely

colle

ct d

ata

on th

eir c

linic

al

activ

ities

and

pat

ient

out

com

es

◥

Sign

ifica

nt d

ecre

ase

in

hosp

italiz

atio

ns

◥In

crea

se in

staff

confi

denc

e; st

rong

disp

lay

of tr

ust

betw

een

othe

r tea

m m

embe

rs

and

the n

urse

pra

ctiti

oner

s

◥lo

w n

urse

pra

ctiti

oner

-re

siden

t rat

io st

ill e

nhan

ces

qual

ity o

f car

e

41m

clou

ghne

y, C

R., K

han,

A., &

Ahm

ed,

A.B

. (20

007)

. Effe

ctiv

enes

s of a

sp

ecia

list n

urse

-led

inte

rven

tion

clini

c in

the m

anag

emen

t of c

ardi

ovas

cula

r ris

k fa

ctor

s in

diab

etes

. Eur

opea

n D

iabe

tes N

ursin

g, 4(

3) 1

00-1

05.

Inte

rven

tion

Clin

ical

St

udy

The

effec

tiven

ess o

f a

spec

ialis

ed n

urse

-led,

pr

otoc

ol d

riven

, doc

tor-

supe

rvis

ed c

linic

uN

ITEd

K

ING

dO

mN

urse

-led

dia

bete

s Car

e

Spec

ialis

t nur

se-le

d in

terv

entio

n cl

inic

in

the

man

agem

ent o

f car

diov

ascu

lar

risk

fact

ors

◥

Nur

se h

ad p

revi

ous e

xper

ienc

e with

di

abet

es/h

yper

tens

ion/

hype

rlipi

-de

mia

; phy

sicia

ns, c

linic

ians

, ph

arm

acist

s, tr

aine

d th

e nur

se o

n ho

w to

impl

emen

t pro

toco

ls

◥N

urse

per

form

ed te

sts,

crea

ted

a

patie

nt m

anag

emen

t pla

n

◥Ea

ch v

isit i

nclu

ded

feed

back

, go

al e

valu

atio

n an

d pl

anni

ng,

asse

ssm

ent o

f sm

okin

g/ob

esity

w

here

app

licab

le

◥

Impr

oved

pat

ient

sa

tisfa

ctio

n, sy

mpt

om

cont

rol,

data

col

lect

ion,

m

edic

al a

nd li

fest

yle

chan

ges

◥

Patie

nts a

chie

ved

bl

ood

pres

sure

con

trol

an

d lip

id ta

rget

s

◥d

iabe

tes c

ontr

ol

signi

fican

tly im

prov

ed


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S42

mile

s, K

. (20

03).C

ompa

ring

doc

tor-

an

d nu

rse-

led

care

in a

sexu

al

heal

th c

linic

: pat

ient

satis

fact

ion

ques

tionn

aire

. Jou

rnal

of A

dvan

ced

Nur

sing,

42(1

), pp

. 64–

72.

Qua

litat

ive

Stud

y

dev

elop

men

t of a

pat

ient

sa

tisfa

ctio

n qu

estio

nnai

re:

Com

pari

ng th

e sa

tisfa

ctio

n of

nur

se-

led

vs. d

octo

r led

ge

nito

urin

ary

clin

ics

uN

ITEd

K

ING

dO

mN

urse

-led

Com

pari

son

doc

tor v

s. N

urse

-led

Clin

ic: G

enito

urin

ary

med

icin

e

◥

Nur

se a

ttend

s edu

catio

nal

inte

rven

tions

; mak

es c

linic

al

asse

ssm

ents

; per

form

s fol

low

-ups

, ap

poin

tmen

t rem

inde

rs; p

rovi

des

regu

lar f

eedb

ack

to p

atie

nt’s

prim

ary

care

pro

vide

r

◥

Syst

emat

ic fo

llow

-ups

with

pa

tient

s had

a p

ositi

ve

outc

ome

on d

etec

ting

depr

essio

n ea

rlier

43m

inist

ry o

f Hea

lth a

nd l

ong-

Term

C

are.

(200

7) N

urse

Pra

ctiti

oner

Led

Cl

inic

s. Re

trie

ved

from

:http

://w

ww.

heal

th.g

ov.o

n.ca

/tra

nsfo

rmat

ion/

np_c

linic

s/np

_mn.

htm

l.

Publ

ic In

form

atio

nC

AN

Ad

A -

ON

TARI

ON

urse

-led

Prim

ary

Car

e

◥

In 2

007

the

min

istry

of H

ealth

and

lo

ng-T

erm

Car

e an

noun

ced

the

crea

tion

of 2

5 nu

rse

prac

titio

ner-

led

clin

ics t

o be

fully

ope

ratio

nal

by th

e en

d of

201

2

◥Th

ese

clin

ics w

ould

del

iver

co

mpr

ehen

sive

and

holis

tic

prim

ary

care

that

wou

ld e

nhan

ce

heal

th p

rom

otio

n, c

hron

ic d

isea

se

man

agem

ent a

nd p

reve

ntio

n

◥Fo

cus o

n in

tegr

ated

car

e

thro

ugh

com

mun

ity p

artn

ersh

ips

and

care

coo

rdin

atio

n

◥

Com

preh

ensiv

e, ac

cess

ible

an

d co

ordi

nate

d fa

mily

he

alth

care

serv

ices

to

com

mun

ities

that

do

not

have

acc

ess t

o a

prim

ary

ca

re p

rovi

der

44m

olza

hn, A

., Bru

ce, A

., & S

hiel

ds,

l . (2

008)

. Sur

veill

ance

de

l’affe

ctio

n ré

nale

chr

oniq

ue d

ans u

ne c

liniq

ue

géré

e pa

r du

pers

onne

l infi

rmie

r et

supe

rvis

ée p

ar d

es m

édec

ins:

l’exp

érie

nce

Can

PREv

ENT.

CJN

R,

40(3

), 96

-112

.

Qua

litat

ive

Rese

arch

St

udy

Exam

inin

g th

e nat

ure o

f ca

re p

rovi

ded

to p

atie

nts

with

chro

nic k

idne

y dise

ase

CA

NA

dA

- BR

ITIS

H

CO

lum

BIA

Nur

se-le

d

Chr

onic

Kid

ney

di s

ease

◥

Clin

ic w

as ru

n by

a n

urse

and

su

ppor

ted

by a

nep

hrol

ogist

◥

Patie

nts c

ontin

ued

to re

ceiv

e ca

re

from

thei

r pri

mar

y ca

re p

hysic

ian

◥

Nur

se w

as w

orki

ng in

par

tner

ship

w

ith p

atie

nts a

nd th

eir f

amili

es to

im

prov

e th

eir h

ealth

and

ove

rall

qual

ity o

f life

◥

Patie

nts d

emon

stra

ted

a be

tter r

espo

nse

to so

me

of th

e no

n-m

edic

al

inte

rven

tions

such

as fl

uid

and

diet

rest

rict

ions

, cou

pled

w

ith re

gula

r sel

f-w

eigh

ing

and

inte

nsiv

e co

unse

lling


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S45

mos

er, A

., Hou

tepe

n, R

. &

wid

ders

hove

n, G

. (20

07) P

atie

nt

auto

nom

y in

nur

se-le

d sh

ared

car

e: a

revi

ew o

f the

oret

ical

and

em

piri

cal

liter

atur

e. Jo

urna

l of A

dvan

ced

Nur

sing,

57(4

), 35

7–36

5.

Theo

retic

al a

nd E

mpi

rica

l li

tera

ture

Rev

iew

How

nur

ses c

an su

ppor

t pa

tient

aut

onom

y

uN

ITEd

K

ING

dO

mN

urse

-led

Hos

pice

Car

e

◥

Shar

ed e

xper

tise

betw

een

patie

nt a

nd p

rofe

ssio

nal;

shar

e re

spon

sibili

ty o

f pro

blem

-sol

ving

◥Pa

tient

sets

goa

ls, p

rofe

ssio

nal h

elps

th

em to

mak

e inf

orm

ed d

ecisi

ons

◥

Patie

nts g

ain

a be

tter

unde

rsta

ndin

g of

thei

r con

ditio

n/be

havi

ours

; pro

blem

s ide

ntifi

ed b

y pa

tient

and

car

egiv

er

◥

Impr

oves

pat

ient

self-

mas

tery

skill

s and

self-

effica

cy, p

ositi

vely

impa

ctin

g cl

inic

al o

utco

mes

46m

oyez

, J., H

alke

tt, G

., dea

s, K

., O’

Con

nor,

m., w

ard,

P., &

O’d

risc

oll,

C. (

2010

). H

ow d

o Sp

ecia

list B

reas

t N

urse

s hel

p br

east

can

cer p

atie

nts a

t fo

llow

-up?

Col

legia

n, 1

7, 1

43-1

49.

Them

atic

Ana

lysis

Con

sulta

tions

bet

wee

n Sp

ecia

list B

reas

t Nur

ses

(SBN

s) a

nd p

atie

nt

AuST

RAlI

AN

urse

-led

Brea

st C

ance

r

◥

The S

BN a

ccom

pani

es ea

ch w

oman

th

roug

h th

is ph

ase i

n he

r life

; th

e SBN

pro

vide

s a v

ery

stro

ng

supp

ortiv

e rol

e – n

orm

aliz

ing,

faci

litat

ion

of se

rvic

es, p

reve

ntio

n,

prom

otin

g se

lf-co

nfide

nce,

embr

acin

g a

proa

ctiv

e app

roac

h

◥

Posit

ive

– pa

tient

s re

spon

ded

effec

tivel

y to

the

fact

that

SBN

s wer

e off

erin

g m

ore

supp

orts

oth

er th

an a

fo

llow

-up

of sy

mpt

oms

47N

aylo

r, m

., Aik

en, l

., Kur

tzm

an, E

., &

Old

s, d

. (20

10).

The I

mpo

rtan

ce o

f Tr

ansit

iona

l Car

e in

Ach

ievi

ng H

ealth

Re

form

. Hea

lth A

ffairs

, 30(

4): 7

46-7

54.

Synt

hesis

Rev

iew

Nur

sing

cont

ribut

ion

to

care

coo

rdin

atio

n an

d tr

ansit

iona

l car

e

GEN

ERA

lN

urse

-led

Prim

ary

Car

e

◥

Chr

onic

Car

e m

odel

: Nur

se

focu

ses o

n pa

tient

edu

catio

n an

d se

lf-m

anag

emen

t to

redu

ce

hosp

italiz

atio

n an

d re

adm

issio

n;

how

to a

dher

e pr

oper

ly

to m

edic

atio

ns

◥

mod

el a

ppea

rs to

hav

e so

me

posit

ive

influ

ence

on

patie

nt

adhe

renc

e an

d qu

ality

of l

ife

◥N

o po

sitiv

e eff

ect o

n m

orta

lity

rate

s

◥N

o ev

iden

ce o

f cos

t-sa

ving

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S48

Nel

son,

K., C

hist

ense

n, S

., Asp

ros,

B., m

cKin

lay,

E.,&

Arc

us, K

. (20

09).

less

ons f

rom

ele

ven

prim

ary

heal

th

care

nur

sing

inno

vatio

ns in

New

Ze

alan

d. In

tern

atio

nal N

ursin

g Re

view

, 56,

291

-298

.

Eval

uatio

n (R

esea

rch

and

dev

elop

men

t App

roac

h)

Eval

uatin

g an

d A

sses

smen

t of v

ario

us

inno

vativ

e m

odel

s in

the

Prim

ary

Car

e se

tting

NEw

- ZE

AlA

Nd

Nur

se-le

d

Prim

ary

Car

e

Nur

se-le

d m

odel

s

◥

Nur

ses h

ave

an e

ssen

tial r

ole

prov

idin

g m

ento

rshi

p, a

dvic

e, an

d ad

voca

cy fo

r pat

ient

s

◥Ro

le o

f nur

sing

lead

ersh

ip

◥Re

gula

tory

env

ironm

ent

◥

Num

erou

s con

text

ual f

acto

rs

◥

Redu

ctio

n in

frag

men

tatio

n in

nur

sing

serv

ices

49N

ew, J

.P., m

ason

, J.m

., Fre

eman

tle, N

., Te

ased

ale,

S., w

ong,

l.m

. & B

ruce

, N

.J. (2

003)

. Spe

cial

ist N

urse

–led

In

terv

entio

n to

Tre

at an

d C

ontr

ol

Hyp

erte

nsio

n an

d H

yper

lipid

emia

in

dia

bete

s (SP

lIN

T). D

iabe

tes C

are,

26,

2250

-225

5.

Ran

dom

ized

Con

trol

led

Impl

emen

tatio

n Tr

ial

Stud

y

det

erm

inin

g th

e eff

ectiv

enes

s of a

nur

se-

led

clin

ic fo

r hyp

erte

nsio

n an

d hy

perli

pide

mia

uN

ITEd

K

ING

dO

mN

urse

-led

◥

dia

bete

s Car

e: H

yper

tens

ion

an

d H

yper

lipid

emia

◥

Nur

ses h

elpe

d to

ass

ess l

ung

func

tion,

car

ried

out

exe

rcis

e te

stin

g, e

duca

tion

on h

ow to

im

prov

e qu

ality

of l

ife, h

ealth

pr

omot

ion;

stud

ied

infe

ctiv

e ex

acer

batio

ns o

f pat

ient

s

◥

No

signi

fican

t diff

eren

ce

betw

een

nurs

e-le

d,

phys

icia

n-le

d cl

inic

◥

Incr

ease

of h

ospi

taliz

ed

visit

s in

nurs

e-le

d ca

re a

nd

re-a

dmiss

ions

50N

urse

-led

Out

reac

h Te

ams o

n th

e Ri

se B

ring

a N

ew K

ind

of ‘H

ouse

C

all’ t

o lo

ng T

erm

Car

e ht

tp://

vote

hele

na.c

a/N

ews/

249?

l=EN

.

web

site A

rtic

leC

AN

Ad

A -

ON

TARI

ON

urse

-led

Prim

ary

Car

e

◥

A n

ew ty

pe o

f hou

se-c

all f

or

long

-ter

m c

are

resid

ents

in th

e C

entr

al l

ocal

Hea

lth In

tegr

atio

n N

etw

ork

(lH

IN)

◥

Gui

ded

by 3

nur

se-le

d ou

trea

ch

team

s, se

nior

s who

bec

ome

acut

ely

ill a

nd w

ho m

ay n

eed

to b

e tr

ansf

erre

d to

the

hosp

ital a

re n

ow

rece

ivin

g th

e ca

re a

nd su

ppor

t th

ey n

eed

in th

eir o

wn

hom

es

◥

Posit

ive

effec

t on

wai

t tim

es;

min

imiz

es tr

ansf

ers t

o th

e em

erge

ncy

depa

rtm

ent

◥

Prov

ides

safe

, hig

h qu

ality

ca

re in

a ti

mel

y m

anne

r


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S51

Palfr

eym

an, S

., Tre

nder

, H., &

Bea

rd, J.

(2

004)

. do

patie

nts w

ith cl

audi

catio

n ne

ed to

see a

vasc

ular

surg

eon?

A

befo

re an

d aft

er st

udy o

f a n

urse

-led

claud

icatio

n cli

nic.

Prac

tice D

evelo

pmen

t in

Hea

lth C

are,

3(1)

53–

64.

Aud

it

Com

pari

ng p

atie

nt

outc

omes

and

qua

lity

indi

cato

rs b

efor

e an

d aft

er th

e in

trod

uctio

n of

a

vasc

ular

nur

se sp

ecia

list

clau

dica

tion

clin

ic

uN

ITEd

K

ING

dO

mN

urse

-led

Car

diov

ascu

lar H

ealth

◥

Nur

se re

ceiv

es re

ferr

al le

tters

fr

om g

ener

al p

ract

ition

er, n

urse

m

akes

app

oint

men

t with

vas

cula

r nu

rse

spec

ialis

t

◥Ph

ysic

al a

sses

smen

ts ar

e com

plet

ed

◥C

onfir

ms d

iagn

osis

of

inte

rmitt

ent c

laud

icat

ion

◥

Redu

ctio

n in

wai

t tim

es

◥Th

orou

gh e

xam

inat

ion

of

patie

nt’s

hist

ory

52Pa

ters

on, B

.l., d

uffet

t-le

ger,

l., &

C

rutte

rden

, K. (

2009

). C

onte

xtua

l Fa

ctor

s Infl

uenc

ing

the

Evol

utio

n of

N

urse

s’ Ro

les i

n a

Prim

ary

Hea

lth

Car

e C

linic

. Pub

lic H

ealth

Nur

sing,

26(5

), 42

1-42

9.

Qua

litat

ive

Stud

y (I

nter

pret

ive

des

crip

tion

des

ign)

Rese

arch

stud

y on

a n

urse

-m

anag

ed C

omm

unity

H

ealth

Clin

ic; e

xam

inin

g ho

w th

e nur

se ro

le

chan

ged

over

tim

e

CA

NA

dA

-

NEw

BR

uN

SwIC

K

Nur

se-le

d

Com

mun

ity H

ealth

Clin

ic –

Pr

imar

y C

are

◥

Soci

o, p

oliti

cal a

nd e

cono

mic

co

ntex

t sha

ped

the

deve

lopm

ent

and

sust

aina

bilit

y of

the

mod

el

◥In

this

mod

el th

e rol

e of t

he n

urse

is

exte

nded

bey

ond

prim

ary

care

to

prov

ide r

elatio

nshi

ps w

ith th

e clie

nts

and

thei

r fam

ilies

, and

to ac

tively

pa

rtic

ipat

e in

the c

omm

unity

◥

The c

linic

is ru

n by

a n

urse

pr

actit

ione

r who

wor

ks w

ith a

so

cial

wor

ker,

outr

each

nur

se, o

ffice

w

orke

r, an

d da

ta en

try

pers

on

◥vo

lunt

eers

in th

e CH

C in

clude

nu

rses

, den

tists

, mas

sage

ther

apist

s, ps

ycho

logi

sts,

men

tal h

ealth

co

unse

llors

, add

ictio

n co

unse

llors

, an

d fo

ot ca

re sp

ecia

lists

◥

The

fund

ing

that

was

pr

ovid

ed fo

r the

CH

C

was

not

suffi

cien

t so

the

nurs

es h

ad to

do

a lo

t of t

he

fund

raisi

ng th

emse

lves

to

enco

urag

e pr

ivat

e do

natio

ns

◥C

urre

nt fu

ndin

g m

echa

nism

s in

plac

e co

ntra

dict

col

labo

rativ

e re

latio

nshi

ps b

y cr

eatin

g co

mpe

titio

n be

twee

n co

mm

unity

age

ncie

s

◥In

this

inst

ance

, nur

ses u

sed

polit

ical

act

ion

as a

mea

ns o

f ca

ring

for i

ndiv

idua

l clie

nts

and

the

com

mun

ity


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S53

Raft

ery,

J. P.

, Yao

, G.l

., mur

chie

, P.

, Cam

pbel

l, N

.C., &

Ritc

hie,

l.d

. (2

005)

. Cos

t Effe

ctiv

enes

s of N

urse

-le

d Se

cond

ary

Prev

entio

n C

linic

s for

C

oron

ary

Hea

rt d

isea

se In

Pri

mar

y C

are:

Follo

w u

p of

a R

ando

mis

ed

Con

trol

led

Tria

l. Br

itish

Med

ical

Jo

urna

l, 33

0(74

93),

707-

710.

Ran

dom

ized

Con

trol

led

Tria

l: C

ost E

ffect

iven

ess

Ana

lysis

Esta

blish

ing

the c

ost

effec

tiven

ess o

f nur

se

led

prev

entio

n cli

nics

for

coro

nary

hea

rt d

iseas

e ba

sed

on fo

ur ye

ars’

follo

w- u

p of

a ra

ndom

ized

co

ntro

lled

tria

l.

uN

ITEd

K

ING

dO

mN

urse

-led

Cor

onar

y H

eart

dis

ease

◥

Nur

ses h

elpi

ng p

atie

nts t

o de

sign

self-

sust

aina

ble

plan

s tha

t inc

lude

fr

eque

nt e

xerc

ise,

good

die

t, sm

okin

g ce

ssat

ion

◥

Stud

y re

sulte

d in

few

er

deat

hs o

f pat

ient

s

◥C

ost-

effec

tive

mod

el th

at

can

save

live

s

54RN

AO. (

2008

). Br

iefing

not

e: in

crea

sing

acce

ss to

prim

ary h

ealth

care

. Br

iefin

g N

ote:

Impr

ovin

g ac

cess

to c

are

thro

ugh

inte

rpro

fess

iona

l co

llabo

ratio

n an

d N

P-le

d C

linic

s

CA

NA

dA

- O

NTA

RIO

NP-

led

Clin

ics

Prim

ary

Car

e

◥

Impr

ove q

ualit

y an

d ac

cess

to

care

for i

ndiv

idua

ls w

ith ch

roni

c di

seas

es b

y en

hanc

ing

chro

nic

dise

ase m

anag

emen

t pro

gram

s; cr

eatin

g m

ore o

ppor

tuni

ties f

or

doct

ors,

nurs

es an

d ot

her h

ealth

care

pr

ovid

ers t

o w

ork

colla

bora

tively

an

d lia

ise w

ith o

ne an

othe

r

◥Fo

cus o

n in

vesti

ng an

d ex

pand

ing

the n

umbe

r of n

urse

pra

ctiti

oner

-le

d cli

nics

in th

e prim

ary

care

sect

or

to im

prov

e pat

ient

acce

ss to

care

◥

Impr

ovin

g ac

cess

to c

are

by

incr

easin

g th

e nu

mbe

r of

nurs

e pr

actit

ione

r pos

ition

s

◥In

crea

se fu

ndin

g fo

r chr

onic

di

seas

e m

anag

emen

t pr

ogra

ms a

nd c

linic

s in

Ont

ario

55Ry

an, S

., Has

sel, A

.B., l

ewis,

m.,

& F

arre

ll A

. (20

06).

Impa

ct o

f a

rheu

mat

olog

y ex

pert

nur

se o

n th

e w

ellb

eing

of p

atie

nts a

ttend

ing

a dr

ug m

onito

ring

clin

ic. J

ourn

al o

f Ad

vanc

ed N

ursin

g, 53

(3),

277-

286.

Ran

dom

ized

Con

trol

led

Tria

l Stu

dy

Nur

se-s

peci

alist

dru

g m

onito

ring

clin

ic w

ith

mea

sure

able

impa

ct o

n th

e w

ell-b

eing

of p

atie

nts

with

rheu

mat

oid

arth

ritis

uN

ITEd

K

ING

dO

mN

urse

-led

Rheu

mat

olog

y

Expe

rt N

urse

– d

rug

mon

itorin

g C

linic

◥

Nur

se ed

ucat

es p

atie

nts o

n st

artin

g ar

thrit

ic sp

ecifi

c med

icat

ion

◥

mon

itors

pat

ient

s for

side

effe

cts

◥

Prov

ides

pat

ient

s with

ong

oing

su

ppor

t and

edu

catio

n

◥

Posit

ive –

help

ed p

atie

nts t

o co

pe w

ith th

eir a

rthr

itis;

mor

e ad

here

nce t

o m

edic

atio

ns,

impr

ovem

ents

in li

festy

les

◥

No

chan

ge –

num

ber o

f co

nsul

tatio

ns o

r cha

nges

in

dru

g th

erap

y


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S56

Scha

dew

aldt

, v. &

Sch

ultz

, T.

(201

1). N

urse

-led

clin

ics a

s an

effec

tive

serv

ice

for c

ardi

ac p

atie

nts:

resu

lts fr

om a

syst

emat

ic re

view

. In

tern

atio

nal J

ourn

al o

f Evi

denc

e Ba

sed

Hea

lthca

re, 9

, 199

-214

.

Syst

emat

ic R

evie

w

Revi

ew o

f effe

ctiv

enes

s of

a N

urse

-led

clin

ic fo

r pa

tient

s with

cor

onar

y he

art d

isea

se

GEN

ERA

lN

urse

-led

Cor

onar

y H

eart

dis

ease

◥

Nur

se-le

d ca

rdia

c cl

inic

s inc

lude

pa

tient

edu

catio

n, ri

sk fa

ctor

as

sess

men

t, co

ntin

uity

of c

are,

coun

selli

ng b

ehav

iour

cha

nge,

prom

otin

g he

alth

y lif

esty

les

◥

Nur

se-le

d ca

re e

quiv

alen

t to

non-

nurs

e-m

anag

ed c

linic

s

◥Pa

tient

s did

not

exp

erie

nce

any

harm

ful o

utco

mes

◥

Posit

ive i

nflue

nce o

n ov

eral

l qu

ality

of l

ife an

d he

alth

stat

us

57Sm

euld

ers,

E., v

an H

aast

regt

, J.,

Am

berg

en, T

., usz

ko-l

ence

r, N

., Jan

ssen

-Boy

ne, J

., & G

orge

ls,

A.(2

010)

Nur

se-le

d se

lf-m

anag

emen

t gr

oup

prog

ram

me

for p

atie

nts w

ith

cong

estiv

e he

art f

ailu

re: r

ando

miz

ed

cont

rolle

d tr

ial.

Jour

nal o

f Adv

ance

d N

ursin

g, 66

(7),

1487

–149

9.

Ran

dom

ized

Con

trol

led

Tria

l

Repo

rt

Ass

essin

g th

e effe

cts o

f th

e Chr

onic

di se

ase S

elf-

man

agem

ent p

rogr

am

(Cd

SmP)

on

patie

nts w

ith

Chr

onic

Hea

rt F

ailu

re

NET

HER

- lA

Nd

SN

urse

-led

Chr

onic

dis

ease

man

agem

ent

◥

Focu

s on

skill

s mas

tery

, in

terp

retin

g sy

mpt

oms,

beha

vior

al

and

soci

al c

hang

es

◥N

urse

s dis

cuss

goa

l-set

ting

and

plan

ning

with

pat

ient

s

◥

Impr

oved

shor

t-te

rm

outc

omes

(cog

nitiv

e sy

mpt

om m

anag

emen

t, se

lf-ca

re b

ehav

iour

, car

diac

-sp

ecifi

c qu

ality

of l

ife)

58So

usa,

K., &

Zun

kel,

G.m

. (20

03).

Opt

imiz

ing

men

tal H

ealth

in a

n A

cade

mic

Nur

se-m

anag

e C

linic

. Jo

urna

l of t

he A

cade

my

of N

urse

Pr

actit

ione

rs, 1

5(7)

, 313

-318

.

Eval

uatio

n (d

escr

iptiv

e Su

rvey

des

ign)

men

tal h

ealth

out

com

es

of c

linic

s in

an a

cade

mic

nu

rsin

g cl

inic

uN

ITEd

ST

ATES

Nur

se-le

d

me n

tal H

ealth

◥

Hel

ping

nur

se p

ract

ition

ers w

ith

the

early

det

ectio

n of

men

tal

heal

th d

isor

ders

so th

ey c

an c

reat

e a

bette

r car

e pl

an fo

r the

pat

ient

in

a m

ore

timel

y w

ay

◥N

urse

pra

ctiti

oner

rece

ives

hel

p w

ith o

nsite

con

sulta

tion

from

a

psyc

hiat

ric

clin

ical

nur

se sp

ecia

list

◥

Inte

grat

ion

of m

enta

l hea

lth

inte

rven

tion

in p

rim

ary

care

setti

ngs h

elps

pro

vide

rs

to o

ptim

ize

thei

r pat

ient

s’ ov

eral

l hea

lth


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S59

Sten

ner K

., Car

ey, N

., & C

ourt

enay

, m

. (20

09) N

urse

pre

scrib

ing

in

derm

atol

ogy:

doc

tors

’ and

non

-pr

escr

ibin

g nu

rses

’ vie

ws.

Jour

nal o

f Ad

vanc

ed N

ursin

g, 65

(4),

851–

859.

Them

atic

Ana

lysis

Expl

orin

g nu

rse

pres

crib

ing

in

derm

atol

ogy

uN

ITEd

K

ING

dO

mN

urse

-led

der

mat

olog

y

◥

Cas

e st

udy

of n

urse

s pr

escr

ibin

g m

edic

atio

ns in

de

rmat

olog

ical

setti

ngs

◥

Patie

nts w

ere

posit

ive

abou

t th

eir e

xper

ienc

e bu

t had

ge

nera

l res

erva

tions

abo

ut

nurs

e pr

escr

ibin

g ov

eral

l

60Ta

ylor

, C.R

., Hep

wor

th, J

.T.,

Buer

haus

, P., d

ittus

, R., &

Spe

roff,

T.

(200

7). E

ffect

of c

rew

reso

urce

m

anag

emen

t on

diab

etes

car

e an

d pa

tient

out

com

es in

an

inne

r-ci

ty

prim

ary

care

clin

ic. Q

ual S

af H

ealth

Ca

re 1

6, 2

44–2

47.

Tim

e Se

ries

Ana

lysis

det

erm

inin

g th

e eff

ectiv

enes

s and

in

nova

tions

in c

hron

ic

dise

ase

man

agem

ent

invo

lvin

g nu

rses

uN

ITEd

K

ING

dO

mN

urse

-led

Chr

onic

dis

ease

man

agem

ent –

Chr

onic

Obs

truc

tive

Pulm

onar

y d

isea

se (C

OPd

)

◥

In th

e ca

se m

anag

emen

t pro

gram

nu

rses

per

form

at-

hom

e vi

sits,

tele

phon

e fo

llow

-ups

, and

pat

ient

ed

ucat

ion

on ta

king

med

icat

ions

an

d sm

okin

g ce

ssat

ion

◥

Nur

se-le

d pr

ogra

ms r

esul

t in

few

er h

ospi

tal a

dmiss

ions

an

d re

adm

issio

ns; s

houl

d be

m

ore

wid

ely

used

; fur

ther

re

sear

ch re

quire

d

61Th

omps

on, K

., Par

ahoo

, K., &

Bla

ir,

N. (

2007

). A

nur

se-le

d sm

okin

g ce

ssat

ion

clin

ic –

qui

t rat

e re

sults

an

d vi

ews o

f par

ticip

ants

. Hea

lth

Educ

atio

n Jo

urna

l, 66

(4),

307-

322.

Eval

uatio

n of

a

Qua

ntita

tive

and

Qua

litat

ive

Stud

y

Eval

uatin

g th

e su

cces

s of

a co

mm

unity

nur

se-le

d sm

okin

g ce

ssat

ion

clin

ic

NO

RTH

ERN

IR

ElA

Nd

Nur

se-le

d

Smok

ing

cess

atio

n

◥

Gro

up th

erap

y ap

proa

ch: n

urse

w

ould

use

a co

mbi

natio

n of

di

rect

ives

to p

rom

ote s

mok

ing

cess

atio

n: g

roup

cons

ulta

tion,

in

divi

dual

s cha

ts, t

elep

hone

follo

w-

ups,

soci

al su

ppor

t, co

ping

skill

s, ca

rbon

mon

oxid

e mon

itorin

g

◥Sm

oker

s cou

ld b

e re

ferr

ed to

the

clin

ic o

r com

e on

thei

r ow

n

◥

Alm

ost 3

0% o

f par

ticip

ants

w

ho a

ttend

ed th

e 6-

wee

k pr

ogra

m q

uit s

mok

ing

◥

wee

kly

carb

on m

onox

ide

mon

itori

ng w

as a

gre

at

ince

ntiv

e to

qui

t

◥m

ost p

artic

ipan

ts w

ould

ha

ve li

ked

a pr

ogra

m lo

nger

th

an 6

wee

ks


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S62

Torr

isi, d

.l. (

2011

). A

Hom

e N

ext

doo

r. St

orie

s fro

m th

e Fie

ld, N

urse

-led

Med

ical

Hom

es: I

ncre

asin

g Acc

ess t

o Q

ualit

y Ca

re, A

pril,

1-2

.

Cas

e St

udy

The fi

rst n

urse

-led

fede

rally

qu

alifi

ed h

ealth

cent

re

uni

ted

Stat

esN

urse

-led

Prim

ary

Car

e

◥

Inte

grat

ed b

ehav

iour

al m

odel

that

al

low

s a th

erap

ist to

see

patie

nts

need

ing

extr

a ca

re fo

r 20-

30

min

utes

up

fron

t on

each

visi

t

◥Pa

tient

s can

dro

p in

or g

et a

sa

me-

day

appo

intm

ent;

48-h

our

turn

arou

nd ti

me

for r

efer

rals;

sh

uttle

to tr

ansp

ort p

atie

nts

with

bar

rier

s

◥

Patie

nts v

ery

satis

fied

with

the

care

they

rece

ive,

allo

win

g th

e pr

ogra

m to

ex

pand

, ser

ving

mor

e th

an

17,0

00 p

atie

nts

◥

Nur

ses fi

nd a

deg

ree

of

auto

nom

y an

d ca

n w

ork

in

a di

vers

e pr

actic

e

63u

nder

woo

d, J.

m., m

owat

, d.l

., m

eagh

er-S

tew

art,

d.m

., deb

er,

R.B.

, Bau

man

n, A

.O., m

acd

onal

d,

m.B

., & A

khta

r-d

anes

h, N

. (20

09).

Build

ing

Com

mun

ity a

nd P

ublic

H

ealth

Nur

sing

Cap

acity

: A S

ynth

esis

Repo

rt o

f the

Nat

iona

l Com

mun

ity

Hea

lth N

ursin

g St

udy.

Cana

dian

Jo

urna

l of P

ublic

Hea

lth, 1

00(5

), 1-

11.

Synt

hesis

Rep

ort

(de m

ogra

phic

Ana

lysis

)

de s

crib

e th

e co

mm

unity

he

alth

nur

sing

wor

kfor

ce

in C

anad

a

CA

NA

dA

Nur

se-le

d

Prim

ary

Car

e

◥

An

effec

tive c

omm

unity

nur

se

mod

el in

clude

s pro

fess

iona

l co

nfide

nce,

stro

ng te

am

rela

tions

hips

, a su

ppor

tive

wor

kpla

ce an

d co

mm

unity

supp

ort

◥

An

envi

ronm

ent t

hat s

uppo

rts

crea

tive

auto

nom

ous p

ract

ice

◥

Fact

ors t

hat c

ontr

ibut

e to

succ

essfu

l pub

lic h

ealth

nu

rsin

g: so

und

polic

y, su

ppor

tive o

rgan

izat

iona

l cu

lture

, goo

d m

anag

emen

t; vi

sion

driv

en b

y co

mm

unity

ne

eds a

nd v

alue

s; fle

xibi

lity

in

fund

ing;

clear

job

desc

riptio

ns

64va

n Zu

lien,

A.d

., Bla

nkes

teijn

, P.J.

, va

n Bu

ren,

m., T

en d

am, m

.A.G

..J.,

Kaa

sjage

r, K

.A.H

., lig

hten

berg

, G.,

& S

ijpke

ns, Y

.w.J.

(201

1). N

urse

pr

actit

ione

rs im

prov

e qu

ality

of c

are

in c

hron

ic k

idne

y di

seas

e: tw

o-ye

ar

resu

lts o

f a ra

ndom

ised

stud

y. Th

e Jo

urna

l of M

edic

ine,

69(1

1), 5

17-5

26.

Ran

dom

ized

Con

trol

led

Clin

ical

Tri

al S

tudy

Is th

e ca

re b

y N

Ps m

ore

effici

ent t

han

phys

icia

ns

for p

atie

nts w

ith c

hron

ic

kidn

ey d

isea

se?

NET

HER

- lA

Nd

SN

urse

-led

Chr

onic

Kid

ney

dis

ease

◥

Nur

ses p

rovi

ding

pat

ient

ed

ucat

ion,

enc

oura

ging

life

styl

e ch

ange

s, be

havi

oura

l cha

nges

in

die

t, in

crea

sing

the

use

of

vita

min

s, he

alth

pro

mot

ion;

pe

rfor

min

g ro

utin

e te

sts s

uch

as

bloo

d pr

essu

re a

nd li

pid

◥

Inte

rven

tion

grou

p le

d by

th

e nu

rse

prac

titio

ner s

aw

a sig

nific

ant i

ncre

ase

in

bloo

d pr

essu

re, l

ipid

and

m

edic

atio

n co

ntro

l. In

crea

se

use

of a

spir

in, v

itam

in d

and

A

CE

inhi

bito

rs


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S65

wat

ts, S

.A., G

ee, J

., O’d

ay, m

.E.,

Scha

ub, K

., law

renc

e, R.

, & K

irsh,

S.

(200

9). N

urse

pra

ctiti

oner

-led

mul

tidis

cipl

inar

y te

ams t

o im

prov

e ch

roni

c ill

ness

car

e: Th

e un

ique

st

reng

ths o

f nur

se p

ract

ition

ers

appl

ied

to sh

ared

med

ical

ap

poin

tmen

ts/g

roup

visi

ts. J

ourn

al

of th

e Am

eric

an A

cade

my

of N

urse

Pr

actit

ione

rs, 2

1¸16

7-17

2.

Cas

e St

udie

s

Exam

inin

g ca

se st

udie

s w

here

NPs

pla

y a

lead

ersh

ip ro

le; i

nflue

nce

of N

Ps o

n sh

ared

med

ical

ap

poin

tmen

ts fo

r pat

ient

s w

ith c

hron

ic il

lnes

s

uN

ITEd

ST

ATES

Nur

se-le

d

Chr

onic

Illn

ess C

are

◥

Nur

se p

ract

ition

er a

dher

ing

to

Chr

onic

Car

e m

o del

gui

delin

es

(wag

ner’s

mod

el)

◥

Nur

se p

ract

ition

er p

artic

ipat

es

in e

duca

ting

patie

nt in

se

lf-m

anag

emen

t, off

erin

g de

cisi

on su

ppor

t, he

lps p

atie

nt to

de

sign

a c

are

plan

that

fits

them

, off

ers c

omm

unity

reso

urce

s, ke

eps t

rack

of p

atie

nt in

a re

gist

ry

and

note

s clin

ical

pro

gres

s (w

hich

m

etho

ds a

re w

orki

ng)

◥

wor

ks w

ith p

hysic

ians

, pha

rmac

ists,

othe

r hea

lth p

rofe

ssio

nals

◥

Nur

se p

ract

ition

er p

rovi

des

holis

tic a

ppro

ach

to c

hron

ic

dise

ase

man

agem

ent

◥

Prom

otes

beh

avio

ural

and

he

alth

cha

nges

in p

atie

nt

66w

i llia

ms,

F.l.

, Bea

ton,

S., G

olds

tein

, P.

, mai

r, F.

, may

, C., &

Cap

ewel

l, S.

(2

005)

. Pat

ient

s’ an

d N

urse

s’ v

iew

s of

Nur

se-l

e d H

eart

Fai

lure

Clin

ics i

n G

ener

al P

ract

ice:

A Q

ualit

ativ

e Stu

dy.

Chro

nic I

llnes

s, 1,

39-

47.

Qua

litat

ive

Stud

y

Nur

ses’

and

patie

nts’

view

s an

d ex

perie

nces

of a

nur

se-

led

hear

t fai

lure

clin

ic

uN

ITEd

K

ING

dO

mN

urse

-led

Car

diov

ascu

lar H

ealth

◥

Nur

ses f

ocus

ed o

n im

prov

ing

nurs

e-pa

tient

com

mun

icat

ion

◥

Educ

ated

pat

ient

s, in

crea

sed

thei

r kn

owle

dge

and

unde

rsta

ndin

g

◥Pr

ovid

ed se

lf-ca

re a

dvic

e

◥Im

prov

ed p

atie

nt’s

unde

rsta

ndin

g of

med

icat

ions

◥

Incr

ease

d pa

tient

’s kn

owle

dge

and

unde

rsta

ndin

g of

th

eir c

ondi

tion

◥

Som

e co

nfus

ion

arou

nd

adhe

ring

to m

edic

ine

and

rem

embe

ring

nur

se’s

advi

ce


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

Nu

rSe

-led

mo

del

S67

won

g, F

. & C

hung

, l. (

2006

). Es

tabl

ishin

g a

defin

ition

for a

nu

rse-

led

clin

ic: s

truc

ture

, pro

cess

an

d ou

tcom

e. Jo

urna

l of A

dvan

ced

Nur

sing,

53(3

), 35

8-36

9.

Expl

orat

ory

Stud

y

defi

ning

a n

urse

-led

clin

ic th

roug

h st

ruct

ure,

proc

ess a

nd o

utco

me

HO

NG

KO

NG

Nur

se-le

d

80%

par

tner

ed w

ith p

hysic

ian

Am

bula

tory

Hea

lth

◥

Nur

ses h

elpe

d w

ith m

edic

atio

n ad

just

men

ts, i

nitia

ted

ther

apie

s, di

agno

stic

test

s, pe

rfor

med

as

sess

men

ts, h

ealth

cou

nsel

ing,

co

ncen

trat

ed o

n sy

mpt

om

man

agem

ent

◥

Hig

h sc

ores

of s

atisf

actio

n fr

om p

atie

nts;

patie

nts

in n

urse

-led

wou

nd a

nd

cont

inen

ce c

linic

s sho

wed

th

e m

ost i

mpr

ovem

ents

68w

orki

ng In

Par

tner

ship

Pro

gram

me

(N/Y

). N

urse

-led

chro

nic d

iseas

e m

anag

emen

t, d

onca

re.

Acc

redi

ted

Revi

ew

Redu

cing

the

wor

kloa

d in

gen

eral

pra

ctic

e by

re

dist

ribut

ing

task

s

uN

ITEd

K

ING

dO

mN

urse

-led

Chr

onic

dis

ease

man

agem

ent

◥

4-pa

rtne

r gen

eral

pra

ctiti

oner

pr

actic

e an

d a

1-ph

ysic

ian

gene

ral

prac

titio

ner p

ract

ice

com

bine

d th

eir p

atie

nts t

o ad

dres

s cha

lleng

es

usin

g a

larg

er su

ppor

t sta

ff

◥N

urse

s tak

ing

the

lead

on

man

agin

g lo

ng-t

erm

chr

onic

co

nditi

ons;

resp

irato

ry c

linic

s, bl

ood

pres

sure

con

trol

, and

oth

ers

◥

dec

reas

e in

wai

t tim

es;

phys

icia

ns co

uld

exte

nd th

eir

appo

intm

ents

with

pat

ient

s

◥Re

duce

s wor

kloa

d, st

ress

le

vels,

hos

pita

l visi

tatio

ns

by p

atie

nts,

impr

ove j

ob

satis

fact

ion

of n

urse

s/do

ctor

s


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

CA

Se m

AN

Ag

emeN

t m

od

elS

1C

icco

ne, m

.m., A

quili

no, A

., &

Cor

tese

, F. (

2010

). Fe

asib

ility

and

eff

ectiv

enes

s of a

dis

ease

and

car

e m

anag

emen

t mod

el in

the

prim

ary

heal

th c

are

syst

em fo

r pat

ient

s w

ith h

eart

failu

re a

nd d

iabe

tes

(pro

ject

leo

nard

o). D

ove P

ress

Jo

urna

l: Va

scul

ar H

ealth

and

Risk

M

anag

emen

t, 6,

297

-305

.

Feas

ibili

ty S

tudy

Stud

ying

a d

iseas

e and

ca

re m

anag

emen

t mod

el

with

“car

e man

ager

’’ nur

ses

ITA

lYC

ase

man

agem

ent

Chr

onic

dis

ease

man

agem

ent

◥

Nur

se a

cts a

s the

car

e m

anag

er

and

is in

cha

rge

of e

mpo

wer

ing

the

patie

nt to

man

age

his/

her

own

heal

th

◥N

urse

pro

vide

s edu

catio

n on

be

havi

oura

l and

life

styl

e ch

ange

s

◥

Patie

nts a

chie

ved

bette

r co

ntro

l of t

heir

dise

ase

◥

very

feas

ible

to in

corp

orat

e th

ese

care

man

ager

s or

spec

ializ

ed n

urse

s to

supp

ort

gene

ral p

ract

ition

ers

2Fr

eund

, T., K

aylin

g, F

., mik

sch,

A.,

Szec

seny

i, J.,

& w

ensin

g, m

. (20

10).

Effec

tiven

ess a

nd e

ffici

ency

of

prim

ary

care

bas

ed c

ase

man

agem

ent

for c

hron

ic d

isea

ses:

ratio

nale

and

de

sign

of a

syst

emat

ic re

view

and

m

eta-

anal

ysis

of ra

ndom

ized

and

no

n-ra

ndom

ized

tria

ls. B

MC

Hea

lth

Serv

ices

Res

earc

h, 1

0(11

2), 1

-4.

Syst

emat

ic R

evie

w

(pro

toco

l)

Impo

rtan

ce o

f cas

e m

anag

emen

t for

ch

roni

cally

ill p

atie

nts

GEN

ERA

lC

ase

man

agem

ent

Cas

e m

anag

emen

t usu

ally

add

ress

es

elem

ents

of t

he c

hron

ic c

are

mod

el

◥

Prov

ides

con

tinui

ty o

f car

e in

th

edel

iver

y sy

stem

, enh

anci

ng

patie

nts’

self-

man

agem

ent s

kills

; co

ntrib

utes

to b

ette

r evi

denc

e-ba

sed

reco

mm

enda

tions

such

as

dia

gnos

is, p

harm

aceu

tical

tr

eatm

ent,

lifes

tyle

cou

nsel

ling,

pa

tient

mon

itori

ng

◥

Sinc

e m

ost c

hron

ical

ly

ill p

atie

nts r

ecei

ve m

edic

al

care

in p

rim

ary

care

se

tting

s, th

is is

whe

re c

ase

man

agem

ent p

rogr

ams a

re

mos

tly im

plem

ente

d

◥Ex

pect

ed o

utco

me:

redu

ctio

n of

hea

lth re

sour

ce

use

by e

nhan

cing

pat

ient

se

lf-m

aste

ry, m

edic

atio

n ad

here

nce,

and

med

icat

ion/

patie

nt m

onito

ring

3

Gid

dens

, J.F

., Tan

ner,

E., F

rey,

K., R

eide

r, l.

, & B

oult,

C. (

2009

). Ex

pand

ing

the

gero

ntol

ogic

al

nurs

ing

role

in g

uide

d ca

re. N

atio

nal

Ger

onto

logi

cal N

ursin

g Ass

ocia

tion,

30

(5),

358-

364.

Pilo

t Stu

dy

One

yea

r Pilo

t Stu

dy

exam

inin

g th

e G

uide

d C

are

Nur

se ro

le in

the

Gui

ded

care

mo d

el

uN

ITEd

ST

ATES

Cas

e m

a nag

emen

t G

uide

d C

are

mo d

el

Prim

ary

Car

e –

Ger

onto

logy

◥

Nur

se c

olla

bora

tes w

ith p

rim

ary

care

pro

vide

rs, p

atie

nts/

care

give

rs,

heal

th a

genc

ies

◥

In c

harg

e of

50-

60 p

atie

nts

◥

Nur

se h

elps

with

ass

essm

ents

, cr

eatin

g an

evi

denc

e-ba

sed

care

pl

an; p

erfo

rms f

ollo

w-u

ps a

nd

care

coo

rdin

atio

n

◥Fa

cilit

ates

acc

ess t

o ca

re,

tran

spor

tatio

n, m

eals,

hom

e m

odifi

catio

n re

sour

ces

◥

Gui

ded

Car

e m

odel

re

sults

in fe

wer

hos

pita

l ad

mis

sion

s; fa

mily

/ca

regi

vers

feel

less

bur

dene

d


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

CA

Se m

AN

Ag

emeN

t m

od

elS

4la

rsso

n, m

., Hed

elin

, B. &

Ath

lin, E

. (2

007)

. A S

uppo

rtiv

e Nur

sing

Car

e C

linic

: Con

cept

ions

of P

atie

nts w

ith

Hea

d an

d N

eck

Can

cer.

Euro

pean

Jo

urna

l of O

ncol

ogy

Nur

sing,

11, 4

9-59

.

Qua

litat

ive

Stud

y (P

heno

men

ogra

-phi

c A

ppro

ach)

des

crib

es h

ow c

ance

r pa

tient

s with

eat

ing

prob

lem

s rec

eive

supp

ort

in a

nur

sing

clin

ic,

befo

re, d

urin

g an

d aft

er

radi

othe

rapy

SwEd

ENC

ase

man

agem

ent

Can

cer C

are

◥

The

nurs

ing

care

clin

ic w

as

com

plem

enta

ry to

the

regu

lar c

are

and

part

icip

atio

n w

as v

olun

tary

◥Th

e fo

cus o

f the

car

e at

this

clin

ic w

as th

e pa

tient

s’ ne

eds o

f nu

triti

onal

car

e, sy

mpt

om c

ontr

ol,

and

soci

al a

nd e

mot

iona

l sup

port

◥

Trea

tmen

t was

mos

t val

uabl

e du

ring

the

peri

ods b

efor

e an

d aft

er c

ompl

etio

n of

the

trea

tmen

t

5N

orri

s, S.

l., N

icho

ls, J.

P., C

aspe

rsen

, C

.J., G

lasg

ow, R

.E., E

ngel

gau,

m.m

., le

onar

d, J.

J., &

Isha

m, G

. (20

02).

The

Effec

tiven

ess o

f dis

ease

and

C

ase

man

agem

ent f

or P

eopl

e w

ith

dia

bete

s. Am

eric

an Jo

urna

l of

Prev

enta

tive M

edic

ine,

22(4

S), 1

5-38

.

Syst

emat

ic R

evie

w

Effec

tiven

ess/

eco

nom

ic

effici

ency

of c

ase/

dise

ase

man

agem

ent f

or p

eopl

e w

ith d

iabe

tes

GEN

ERA

lC

ase

man

agem

ent

◥

Patie

nt re

ceiv

es c

ouns

ellin

g,

addi

tiona

l hea

lth e

duca

tion,

re

min

ders

and

supp

ort

inte

rven

tions

(com

mun

ity

or h

ealth

care

) for

dis

ease

m

anag

emen

t and

cas

e m

anag

emen

t whe

n ne

cess

ary

◥

Impr

ovin

g pa

tient

gly

cem

ic

cont

rol a

nd m

onito

ring

of

gly

cem

ic c

ontr

ol b

y th

e he

alth

care

pro

vide

r

◥Eff

ectiv

e w

ith o

r with

out

dise

ase

man

agem

ent b

ut

in c

onju

nctio

n w

ith o

ne o

r m

ore

educ

atio

n, re

min

der

of su

ppor

t int

erve

ntio

n6

van

de r

Slu

is, C

.K., d

a tem

a, l.

, Saa

n,

I., S

tant

, d., &

dijk

stra

, P.u

. (20

08).

Effec

ts o

f a n

urse

pra

ctiti

oner

on

a m

ultid

isci

plin

ary

cons

ulta

tion

team

. Jo

urna

l of A

dvan

ced

Nur

sing,

65(3

), 62

5-63

3.

Tim

e Se

ries

Ana

lysis

wh a

t are

the

effec

ts o

f an

NP

on a

mul

tidis

cipl

inar

y te

am fo

r pat

ient

s with

rh

eum

atoi

d ar

thrit

is;

com

pari

son

of a

n in

terv

entio

n an

d co

ntro

l gr

oup

usin

g a

time

se

ries

des

ign

NET

HER

- lA

Nd

SC

ase

man

agem

ent

Rheu

mat

olog

y/A

rthr

itis

◥

Team

con

siste

d of

a

rheu

mat

olog

ist, r

ehab

ilita

tion

phys

icia

n, p

last

ic su

rgeo

n,

occu

patio

nal t

hera

pist

◥

NP

gath

ered

pat

ient

dat

a, di

d a

prel

imin

ary

asse

ssm

ent,

coor

dina

ted

surg

ery

and

acte

d

as th

e ca

se m

anag

er

◥

Impr

oved

wai

t tim

es, p

atie

nt

satis

fact

ion

leve

ls, a

nd

orga

niza

tion

of th

e offi

ce


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

1C

ampb

ell,

C., C

raig

, J., E

gger

t, J.,

& B

aile

y-d

orto

n, C

. (20

10).

Impl

emen

ting

and

mea

suri

ng th

e im

pact

of p

atie

nt n

avig

atio

n at

a

com

preh

ensiv

e co

mm

unity

can

cer

cent

re. O

ncol

ogy

Nur

sing

Foru

m,

37(1

), 61

-68.

Prog

ram

Eva

luat

ion

Are

pat

ient

s mor

e sa

tisfie

d w

ith p

atie

nt

navi

gatio

n in

Com

mun

ity

Can

cer C

entr

es

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n

Can

cer C

are

◥

Nur

se n

avig

ator

car

ing

for p

atie

nt

from

dia

gnos

is to

end

of t

reat

men

t

◥

Surv

ey sh

owed

im

prov

emen

ts in

pat

ient

sa

tisfa

ctio

n of

car

e

◥St

aff sa

tisfie

d w

ith p

atie

nt-

navi

gate

d ca

re

2C

ance

r Car

e Ont

ario

. (20

10).

Onc

olog

y N

ursin

g Pr

ogra

m

New

slette

r. O

ncol

ogy

Nur

sing P

rogr

am.

Toro

nto:

Ont

ario

, 1-6

, Ret

rieve

d fro

m:

ww

w.ca

ncer

care

.on.

ca.

New

slette

rC

AN

Ad

A

ON

TARI

OPa

tient

Nav

igat

ion

Onc

olog

y

◥

Ove

rvie

w o

f CC

O P

atie

nt

Nav

igat

ion

pilo

t pro

gram

. Cou

rse

deve

lope

d w

ith d

e Sou

za In

stitu

te

cove

rs co

mm

unic

atio

n, a

sses

smen

t, sc

reen

ing

for d

istre

ss, c

ultu

re

and

dive

rsity

, soc

ial s

uppo

rt, a

nd

com

mun

ity re

sour

ces.

Base

d on

Su

ppor

tive C

are m

odel

(Fitc

h,

2000

) and

the S

ocia

l Cog

nitiv

e Tr

ansit

iona

l mod

el o

f Adj

ustm

ent

(Bre

nnan

, 200

5).

◥

No

outc

omes

dis

cuss

ed

3C

arro

ll, J.K

., Hum

iston

, S.G

., me ld

rum

, S.

C., S

alam

one,

C.m

., Jea

n-Pi

erre

, P.,

Epste

in, R

.m., &

Fisc

ella,

K. (

2009

). Pa

tient

s’ ex

perie

nces

with

nav

igat

ion

for c

ance

r car

e. Pa

tient

Edu

catio

n an

d Co

unse

ling,

80, 2

41-2

47.

Ran

dom

ized

Con

trol

led

Tria

l

Patie

nt e

xper

ienc

es w

ith

patie

nt n

avig

atio

n

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n

Can

cer C

are

◥

Nur

se n

avig

ator

wor

ks w

ith

patie

nts w

ith a

bnor

mal

bre

ast/

colo

rect

al c

ance

r fro

m d

iagn

osis

to e

nd o

f tre

atm

ent

◥

Patie

nts r

ecei

ving

nav

igat

ion

expe

rien

ce le

ss is

olat

ion;

un

ders

tand

the

info

rmat

ion

proc

ess b

ette

r; di

agno

sis/

trea

tmen

t opt

ions

◥

Patie

nts p

refe

r not

to h

ave

mal

e pa

tient

nav

igat

ors f

or

brea

st c

ance

r cas

es


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

4El

l, K

., vou

rleki

s, B.

, lee

, P-J

., & X

ie,

B. (2

006)

. Pat

ient

nav

igat

ion

and

case

m

anag

emen

t fol

low

ing

an a

bnor

mal

m

amm

ogra

m: a

rand

omiz

ed c

linic

al

tria

l. Pr

even

tativ

e Med

icin

e, 44

, 26-

33.

Ran

dom

ized

C

ontr

olle

d Tr

ial

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n an

d

Cas

e m

anag

emen

t

low

inco

me,

ethi

c w

omen

– k

eepi

ng

appo

intm

ents

for m

amm

ogra

ms

◥

Scre

enin

g Adh

eren

ce F

ollo

w u

p (S

AFe

) mod

el w

as u

sed:

stru

ctur

ed

telep

hone

-bas

ed, p

atien

t-cen

tred

adhe

renc

e risk

asse

ssm

ent, e

duca

tion,

co

unse

lling

, nav

igat

ion

assis

tanc

e, tra

ckin

g, re

min

ders

and

refe

rrals

to

com

mun

ity re

sour

ces;

asse

ssm

ent o

f ba

rrier

s; us

e of c

linica

l alg

orith

m to

as

sign

serv

ice le

vels

◥

Sign

ifica

nt in

crea

se in

ad

here

nce

to a

ppoi

ntm

ents

◥

Adh

eren

ce v

arie

d w

ith le

vel

of in

tens

ity o

f int

erve

ntio

n

5Fe

rran

te J.

m., C

hen

P.H

. & K

im

S. (2

007)

. The

effec

t of p

atie

nt

navi

gatio

n on

tim

e to

dia

gnos

is,

anxi

ety

and

satis

fact

ion

in u

rban

m

inor

ity w

omen

with

abn

orm

al

mam

mog

ram

s: a

rand

omiz

ed

cont

rolle

d tr

ial.

Jour

nal o

f Urb

an

Hea

lth, 8

5, 1

14–1

24.

Ran

dom

ized

C

ontr

olle

d Tr

ail

Patie

nt N

avig

atio

n

Follo

w u

p w

ith a

bnor

mal

m

amm

ogra

ms –

impr

ove

timel

ines

s to

dia

gnos

is an

d pa

tient

satis

fact

ion

◥

Nav

igat

ion

– m

eetin

g sp

ecifi

c ne

eds o

f wom

en –

em

otio

nal

and

soci

al su

ppor

t, m

akin

g ap

poin

tmen

ts, b

eing

pre

pare

d fo

r app

oint

men

t, ap

plic

atio

n fo

r fin

anci

al a

ssist

ance

, lin

king

to

reso

urce

s and

supp

ort s

yste

ms,

faci

litat

ing

inte

ract

ions

and

co

mm

unic

atio

n w

ith h

ealth

care

st

aff a

nd p

rovi

ders

◥

Sign

ifica

nt p

ositi

ve fi

ndin

gs

– im

prov

emen

ts in

tim

e to

di

agno

sis, d

ecre

ased

anx

iety

an

d in

crea

sed

satis

fact

ion


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

6G

ilber

t, J.E

., Gre

en, E

., lan

kshe

ar, S

., H

ughe

s, E.

, Bur

kosk

i, v., &

Saw

ka, C

. (2

010)

. Nur

ses a

s pat

ient

nav

igat

ors i

n ca

ncer

dia

gnos

is: re

view

, con

sulta

tion

and

mod

el d

esig

n. E

urop

ean

Jour

nal

of C

ance

r Car

e, 20

, 228

-236

.

lite

ratu

re R

evie

w

(Syn

thes

is)G

ENER

Al

- C

AN

Ad

APa

tient

Nav

igat

or

Can

cer C

are

◥

Nur

se a

ssist

s pat

ient

s thr

ough

th

e di

agno

stic

pha

se o

f can

cer

◥

Nur

se e

xpos

es p

atie

nt to

va

riou

s hea

lthca

re su

ppor

ts;

com

mun

icat

es w

ith p

hysic

ians

an

d on

colo

gist

s

◥N

urse

take

s par

t in

mul

tidis

cipl

inar

y ca

se c

onfe

renc

es

on th

e pa

tient

in q

uest

ion

◥

dia

gnos

is tim

e is

redu

ced

with

an

incr

ease

in fo

llow

-up

s; sh

orte

r wai

t tim

es;

hosp

ital s

tays

◥

Phys

icia

n ha

s mor

e tim

e to

fo

cus o

n co

mpl

ex c

ases

and

pa

tient

anx

iety

is re

duce

d

◥C

are

is m

ore

coor

dina

ted,

or

gani

zed;

pat

ient

is

bette

r inf

orm

ed a

nd c

are

plan

exp

edite

d

7G

uada

gnol

o, B.

A., C

ina,

K., K

oop,

d.,

Brun

ette

, d., &

Pet

erei

t, d

.G. (

2011

). A

pr

e-po

st su

rvey

anal

ysis

of sa

tisfa

ctio

n w

ith h

ealth

care

and

med

ical

m

istru

st aft

er p

atie

nt n

avig

atio

n fo

r A

mer

ican

Indi

an ca

ncer

pat

ient

s. Jo

urna

l of H

ealth

care

for t

he P

oor a

nd

Und

erse

rved

, 22,

1331

-134

3.

Pre-

Post

Coh

ort

Stud

y Su

rvey

Patie

nt n

avig

atio

n sa

tisfa

ctio

n am

ong

Am

eric

an In

dian

ca

ncer

pat

ient

s

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n

Am

eric

an In

dian

can

cer p

atie

nts

◥

Nur

ses r

ecei

ving

spec

ific

educ

atio

n in

nur

se n

avig

atio

n;

cultu

rally

trai

ned

◥

Focu

s on

redu

cing

ba

rrie

rs a

nd a

cces

s to

care

fo

r vul

nera

ble

popu

latio

ns

◥

Impr

oved

satis

fact

ion

of

patie

nts a

fter r

ecei

ving

pa

tient

nav

igat

ion

◥

No

signi

fican

t im

prov

emen

ts

in m

istru

st, b

ut h

igh

satis

fact

ion

rate

s of p

atie

nts

duri

ng c

ance

r tre

atm

ent


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

8m

ande

rson

, B., m

cmur

ray,

J., P

irain

o,

E., &

Sto

lee,

P. (2

012)

. Nav

igat

ion

Role

s Sup

port

Chr

onic

ally

Ill

Old

er A

dults

thro

ugh

Hea

lthca

re

Tran

sitio

ns: A

Sys

tem

atic

Rev

iew

of

the

l ite

ratu

re. H

ealth

and

Soc

ial C

are

in th

e Com

mun

ity, 2

0(2)

, 113

-127

.

Syst

emat

ic R

evie

w

Avoi

ding

too

man

y he

alth

care

tran

sitio

ns

whi

ch u

sual

ly re

sults

in

frag

men

ted

care

; cas

e in

poi

nt c

hron

ical

ly il

l ol

der a

dults

GEN

ERA

lPa

tient

Nav

igat

ion

◥

Role

of a

nav

igat

or fo

r the

ch

roni

cally

ill o

lder

per

son

is a

rela

tivel

y ne

w o

ne; i

nclu

des t

he

crea

tion

of p

atie

nt-p

rovi

der c

are

plan

s and

trea

tmen

t goa

ls

◥m

ost s

tudi

es fo

cuse

d on

hos

pita

l-ho

me

tran

sitio

ns fo

r pat

ient

s (d

isch

arge

pla

nnin

g)

◥Pa

tient

nav

igat

ion

incl

uded

ph

one

supp

ort,

hom

e vi

sits,

patie

nt e

duca

tion,

acc

ess t

o co

mm

unity

serv

ices

◥

vari

ous b

ased

on

st

udy/

cont

ext

◥

Posit

ive:

impr

ovem

ents

in

car

egiv

er a

nd p

atie

nt

com

mun

icat

ion,

self-

man

agem

ent t

echn

ique

s, ad

here

nce

to m

edic

atio

ns,

decr

ease

in E

R us

e, im

prov

ed m

enta

l hea

lth,

mor

e co

mm

unity

refe

rral

s

◥N

egat

ive:

disc

ontin

uity

of

care

, (la

ck o

f tra

nsiti

on) f

or

chro

nica

lly il

l old

er a

dults

, es

peci

ally

thos

e with

mul

tiple

ch

roni

c dise

ases

; too

man

y ho

spita

l adm

issio

ns9

Ngu

yen,

T. &

Kag

awa-

Sing

er, m

. (2

008)

. Ove

rcom

ing

Barr

iers

to

Can

cer C

are

Thro

ugh

Hea

lth

Nav

igat

ion

Prob

lem

s. Se

min

ars i

n O

ncol

ogy

Nur

sing,

24(4

), 27

0-27

8.

Ove

rvie

w o

f Theo

retic

al

Con

cept

s

Theo

retic

al co

ncep

ts in

co

mm

unity

bas

ed cu

ltura

lly

tailo

red

healt

h na

viga

tion

uN

ITEd

ST

ATES

Patie

nt N

avig

ator

Com

mun

ity N

avig

ator

or l

ay H

ealth

Can

cer C

are

◥

Com

mun

ity N

avig

ator

s ass

ist

with

task

s suc

h as

sche

dulin

g ap

poin

tmen

ts, p

rovi

ding

tr

ansp

orta

tion,

coo

rdin

atin

g ca

re, e

nsur

ing

follo

w-u

ps a

re in

pl

ace,

arra

ngin

g fin

anci

al su

ppor

t, co

mm

unity

out

reac

h

◥

Nur

ses n

eed

to b

e m

ore

proa

ctiv

e in

del

iver

ing

care

th

at is

cul

tura

lly se

nsiti

ve,

com

mun

ity b

ased


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

10Pe

ders

en, A

., & H

ack,

T. (

2010

). Pi

lots

of

Onc

olog

y H

ealth

Car

e: A

Con

cept

A

naly

sis o

f the

Pat

ient

Nav

igat

or R

ole.

Onc

olog

y N

ursin

g For

um, 3

7(1)

, 55-

60.

Con

cept

Ana

lysis

Role

of p

atie

nt n

avig

ator

in

onc

olog

y

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n

Can

cer C

are

◥

Role

of t

he P

atie

nt N

avig

ator

(PN

): Fa

cilit

ates

acc

ess t

o ca

re, p

rovi

des

educ

atio

n, li

nks t

o re

sour

ces,

redu

ces b

arrie

rs su

ch a

s lan

guag

e/cu

ltura

l/ tr

ansp

orta

tion

issue

s

◥

Fam

ilies

rece

ive

acce

ss

to h

ealth

reso

urce

s in

a ti

mel

y m

anne

r

◥Pa

tient

s fee

l mor

e em

pow

ered

thro

ugh

educ

atio

n se

ssio

ns

◥PN

s are

wel

l tra

ined

in th

e ca

ncer

syst

em, a

llevi

atin

g pa

tient

inse

curit

ies

11Ps

ooy,

Bria

n, S

chre

uer,

J., B

orga

onka

r, d

., Cai

nes,

J. &

Judy

, S. (

2004

). Pa

tient

N

avig

atio

n: Im

prov

ing

Tim

elin

ess i

n th

e dia

gnos

is of

Bre

ast A

bnor

mal

ities

. Ca

nadi

an A

ssoc

iatio

n of

Rad

iolo

gists

Jo

urna

l, 55

(3),

145-

150.

Retr

ospe

ctiv

e

Coh

ort S

tudy

Rese

arch

stud

y de

term

inin

g th

e im

pact

of

pat

ient

nav

igat

ion

and

timeli

ness

whe

n di

agno

sing

brea

st ab

norm

aliti

es

CA

NA

dA

- N

OvA

SC

OTI

APa

tient

Nav

igat

ion

Brea

st C

ance

r

◥

Patie

nt n

avig

ator

con

tact

s th

e ph

ysic

ian

dire

ctly

whe

n a

brea

st le

sion

requ

irin

g fu

rthe

r in

vest

igat

ion

occu

rs

◥Pa

tient

nav

igat

or w

ill b

ook

a di

agno

stic

imag

ing

or c

ore

need

le

biop

sy a

ppoi

ntm

ent

◥

Early

not

ifica

tion

allo

ws t

he

phys

icia

n tim

e to

con

tact

the

patie

nt in

adv

ance

and

pro

vide

su

rgic

al c

onsu

ltatio

n if

need

ed

◥C

ases

are

follo

wed

dili

gent

ly to

en

sure

that

pat

ient

s do

not l

ose

out o

n fo

llow

-ups

◥

The

patie

nt n

avig

ator

will

m

inim

ize

patie

nt a

nxie

ty a

nd

ther

e is

min

imal

inte

rfer

ence

with

pa

tient

or p

hysic

ian

auto

nom

y

◥

Posit

ive

resu

lts re

sulti

ng in

a

decr

ease

in w

ait-

times

from

20

to 1

4 da

ys

◥Po

tent

ially

impr

ove

qual

ity

of li

fe fo

r pat

ient

s with

be

nign

con

ditio

ns a

nd

prov

ide

earli

er tr

eatm

ent f

or

thos

e w

ith m

alig

nant

cas

es


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

PAt

IeN

t N

AVIg

AtIo

N m

od

elS

12w

ells,

K.J.

, mea

de, .C

.d., &

Cal

cano

, E.

(201

1). I

nnov

ativ

e App

roac

hes t

o Re

duci

ng C

ance

r Hea

lth d

ispar

ities

. Jo

urna

l of C

ance

r Edu

catio

n, 26

, 649

-657

.

Ran

dom

ized

C

ontr

olle

d Tr

ial

(Coh

ort S

tudy

des

ign)

Effica

cy in

pat

ient

na

viga

tion

in re

duci

ng

scre

enin

g de

lays

uN

ITEd

ST

ATES

Patie

nt N

avig

atio

n

Can

cer C

are

◥

An

acce

ptab

le p

atie

nt n

avig

atio

n pr

ogra

m w

as d

esig

ned;

a

rand

omiz

ed c

ontr

ol tr

ial e

valu

ated

th

e pr

ogra

m; d

issem

inat

ion

of

the

rese

arch

find

ings

det

erm

ined

if

patie

nt n

avig

atio

n re

duce

d sc

reen

ing

dela

ys

◥Pr

actic

e Nur

ses (

PNs)

rece

ive

trai

ning

in d

iagn

ostic

and

treat

men

t fo

r bre

ast/c

olor

ecta

l can

cer

◥

PNs a

ssist

with

rem

ovin

g pa

tient

ba

rrie

rs: t

rans

latio

n, in

terp

reta

tion,

pa

perw

ork,

hos

pice

serv

ices

◥

Nee

d fo

r new

mat

eria

ls su

rfac

ed d

ue to

pat

ient

la

ngua

ge b

arri

ers;

crea

tion

of ‘’i

nstr

uctio

ns fo

r a

colo

nosc

opy

prep

arat

ion’

’

◥N

o co

nclu

sive

resu

lts y

et o

n w

heth

er p

atie

nt n

avig

atio

n re

duce

s scr

eeni

ng d

elay

s

◥O

utco

me

resu

lts w

ere

not

avai

labl

e –

stud

y in

pro

gres

s

13w

hite

, S. R

., Con

roy,

B., S

lavi

sh, K

.H.,

& R

osen

zwei

g, m

. (20

10).

Patie

nt

Nav

igat

ion

in B

reas

t Can

cer.

Canc

er

Nur

sing,

33(2

), 12

7-14

0.

Syst

emat

ic R

evie

w

Eval

uatin

g pa

tient

na

viga

tion

in b

reas

t ca

ncer

car

e

GEN

ERA

lPa

tient

Nav

igat

ion

Brea

st C

ance

r

◥

Patie

nt N

avig

atio

n m

odel

– so

me

mod

els i

nclu

de so

cial

wor

kers

and

la

y-he

alth

per

sons

◥

Focu

s on

redu

cing

dia

gnos

is tim

e, ad

dres

sing

lingu

istic

, soc

ial,

cultu

ral,

econ

omic

bar

rier

s, co

mm

unity

out

reac

h, im

prov

e sc

reen

ing

rate

s

◥

Patie

nt n

avig

atio

n

impr

oved

adh

eren

ce to

br

east

can

cer c

are;

scre

enin

g,

diag

nosis

, tre

atm

ent


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S1

Ake

royd

, J., O

anda

san,

I., A

lsaffa

r, A

., whi

tehe

ad, C

., & l

inga

rd, l

. (2

009)

. Per

cept

ions

of t

he R

ole

of

the

Regi

ster

ed N

urse

in a

n u

r ban

In

terp

rofe

ssio

nal A

cade

mic

Fam

ily

Prac

tice

Setti

ng. N

ursin

g Le

ader

ship

, 22

(2) 7

3-84

.

Cas

e St

udy

util

izat

ion

of th

e nu

rsin

g w

orkf

orce

and

the

nurs

ing

role

CA

NA

dA

- G

ENER

Al

Shar

ed C

are

Prim

ary

care

◥

Fam

ily p

hysic

ian

(FP)

and

re

gist

ered

nur

se (R

N) w

orki

ng

in c

olla

bora

tion

to m

axim

ize

the

need

and

car

e of

pat

ient

s

◥d

ecre

ase

role

am

bigu

ity

◥In

crea

se tr

ustw

orth

ines

s bet

wee

n th

e FP

and

RN

◥

Impr

oved

wai

t tim

es, p

atie

nt

acce

ss to

car

e

◥C

ontin

uing

edu

catio

n in

cent

ives

for R

Ns t

o in

crea

se le

vels

of tr

ust

2A

llen,

J K

., den

niso

n, C

.R.,

Him

mel

farb

, d., S

zant

on, S

.l.,

Bone

, l., H

ill, m

.N., &

le v

ine,

d. m

. (2

011)

. Coa

ch T

rial

: A ra

ndom

ized

co

ntro

lled

tria

l of n

urse

pra

ctiti

oner

/ co

mm

unity

hea

lth w

orke

r ca

rdio

vasc

ular

dis

ease

risk

redu

ctio

n in

urb

an c

omm

unity

hea

lth c

ente

rs:

Rat

iona

le a

nd d

esig

n. C

onte

mpo

rary

Cl

inic

al T

rial

s, 32

, 403

-411

.

Cas

e St

udy

Car

diov

ascu

lar H

ealth

Tr

ial i

n fe

dera

lly q

ualifi

ed

com

mun

ity h

ealth

cen

tres

uN

ITEd

ST

ATES

Shar

ed C

are

(N

P an

d C

Hw

)

Car

diov

ascu

lar d

isea

se

◥

Focu

s on

nurs

e ca

se m

anag

ers

and

com

mun

ity h

ealth

wor

kers

to

bein

g eff

ectiv

e th

erap

y st

rate

gies

to

poo

rly fu

nded

hea

lth c

entr

es

◥Fo

cus o

n pa

tient

edu

catio

n,

coun

selli

ng a

nd te

leph

one

follo

w-

ups t

o in

crea

se p

atie

nt a

dher

ence

◥

Nur

ses a

nd co

mm

unity

he

alth

wor

kers

dev

elop

stron

g re

latio

nshi

ps w

ith p

atie

nts

◥

Prov

ide

heal

thca

re se

rvic

es

to th

e un

ders

erve

d w

here

tr

aditi

onal

out

reac

h st

rate

gies

fail

3Be

aulie

u, m

.d. (

2007

). Fa

mily

pr

actic

e Te

ams:

Prof

essio

nal R

ole

Iden

tity.

Intr

oduc

tion

to th

e Ses

sion,

O

verv

iew

of t

he L

itera

ture

: Hea

lth

Cana

da F

MF

Sess

ion.

Pow

er P

oint

Sl

ides

, 1-8

9.

Pres

enta

tions

of

seve

ral a

utho

rsC

AN

Ad

ASh

ared

Car

e an

d

Inte

rpro

fess

iona

l tea

m

Gen

eral

◥

Ove

rvie

w o

f fam

ily p

ract

ice

in

Can

ada;

Nov

a Sc

otia

surv

ey w

ith

fam

ily p

ract

ice

nurs

es; a

cces

s to

prim

ary

care

; qua

lity

indi

cato

rs

◥

No

spec

ific o

utco

mes

; fac

tors

fo

r suc

cess

ful t

eam

s disc

usse

d


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S4

Brow

n, J.

B., S

mith

, C., S

tew

art,

m.,

Trim

, K., F

reem

an, T

., Bec

khoff

, C.,

& K

aspe

rski

, J.m

. (20

09).

leve

l of

acce

ptan

ce o

f diff

eren

t mod

els o

f m

ater

nity

car

e. Th

e Can

adia

n N

urse

, 10

5(1)

, 19-

23.

Cro

ss-S

ectio

nal S

urve

y

Exam

inin

g fiv

e pr

opos

ed

mat

erni

ty m

odel

s

CA

NA

dA

- O

NTA

RIO

Shar

ed C

are

mat

erni

ty C

are

A:

labo

ur a

nd d

eliv

ery

care

for

phys

icia

n’s p

atie

nts

B:

labo

ur a

nd d

eliv

ery

care

for

phys

icia

ns’ a

nd m

idw

ives

’ pat

ient

sC

: la

bour

and

del

iver

y ca

re fo

r ph

ysic

ians

pat

ient

s, pa

rtne

ring

w

ith m

idw

ives

d:

labo

ur a

nd d

eliv

ery

care

for

phys

icia

ns p

atie

nts a

nd a

ssist

ing

mid

wiv

es a

t bir

thE:

In

terp

rofe

ssio

nal c

linic

setti

ng

◥

Pref

erre

d m

etho

d of

the

73

0 nu

rses

that

wer

e su

rvey

ed w

as th

e fir

st o

ne

(44.

8% a

ppro

val)

◥

Nur

ses w

ere

wea

ry o

f co

llabo

ratin

g w

ith m

idw

ives

; ex

pres

sing

resis

tanc

e to

cha

nge

and

lack

of

com

mun

icat

ion

that

wou

ld

prev

ent a

n IP

setti

ng

◥If

the I

P m

odel

was

gui

ded

by

nurs

es an

d em

phas

ized

role

cl

arity

, the

n nu

rses

wou

ld b

e m

ore w

illin

g to

impl

emen

t it

5El

y, d

.S., d

el-m

ar C

.B., &

Pat

ters

on,

E. (2

008)

. A N

urse

-led

mod

el o

f C

hron

ic d

isea

se C

are

– A

n In

teri

m

Repo

rt. A

ustr

alia

n Fa

mily

Phy

sicia

n,

37(1

2), 1

030-

1032

.

Inte

rim

Rep

ort -

qu

alita

tive

Inve

stig

atin

g a

nurs

e-le

d ch

roni

c co

nditi

on m

odel

; its

cos

t, eff

ectiv

enes

s,

and

feas

ibili

ty

AuST

RAlI

ASh

ared

Car

e

◥

The

nurs

e w

orks

in p

artn

ersh

ip

with

the

GP

and

each

pat

ient

is

revi

ewed

on

a 6-

mon

th b

asis

by

the

GP

and

the

prac

tice

nurs

e

◥

Incr

ease

d effi

cien

cy

and

com

mun

icat

ion

◥

Incr

ease

d at

tent

ion

to d

etai

l an

d sy

stem

atic

car

e

◥Re

latio

nshi

ps b

etw

een

the

nurs

e and

pat

ient

s wer

e str

engt

hene

d; p

atie

nts m

ore

will

ing

to v

oice

thei

r con

cern

s

◥ F

ollo

w-u

ps w

ith p

atie

nts

wer

e m

ore

cons

isten

t an

d co

mpl

eted

with

in

appr

opri

ate

time

fram

es

◥Pa

tient

s bec

ame

mor

e m

otiv

ated

and

resp

onsi

ve

to c

hron

ic d

isea

se

man

agem

ent c

are


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S6

Gri

ffith

s, C

., mile

s, K

., Ald

am, d

., C

ornf

orth

, d., m

into

n, J.

, Edw

ards

, S.

, & w

illia

ms,

I. (2

007)

. A n

urse

-ph

arm

acist

-led

trea

tmen

t adv

ice

clin

ic fo

r pat

ient

s atte

ndin

g an

HIv

o

outp

atie

nt c

linic

. Jou

rnal

of A

dvan

ced

Nur

sing,

54(5

), 32

0-32

6.

Qua

litat

ive

Stud

y

Can

diff

eren

t tre

atm

ent

advi

sors

impr

ove a

dher

ence

to

HIv

trea

tmen

t

uN

ITEd

K

ING

dO

mSh

ared

Car

e

HIv

Clin

ic

2 re

sear

ch n

urse

s and

pha

rmac

ist: H

Iv

Out

patie

nt c

linic

◥

wor

ked

in a

trea

tmen

t adv

isor

y cl

inic

(TA

C) t

o in

crea

se p

atie

nt

know

ledg

e su

rrou

ndin

g H

Iv

and

the

HA

ART

(hig

hly

activ

e an

tivira

l the

rapy

) to

help

with

pa

tient

dec

ision

-mak

ing

and

long

-te

rm a

dher

ence

to th

e th

erap

y

◥

Tele

phon

e su

ppor

t inc

reas

ed

patie

nt a

dher

ence

7H

ickm

an, m

., dr u

mm

ond,

N., &

G

rim

shaw

, J. (

1994

). A

Tax

onom

y of

Sha

red

Car

e fo

r Chr

onic

dis

ease

. Jo

urna

l of P

ublic

Hea

lth M

edic

ine,

16(4

), 44

7-45

4.

Two-

Phas

e Po

stal

Q

uest

ionn

aire

Sur

vey

Cre

atin

g a

com

posit

ion

of

shar

ed-c

are

appr

oach

es

to a

ddre

ss a

reas

of

chro

nic

dise

ase

uN

ITEd

K

ING

dO

mSh

ared

Car

e

Shar

ed C

are

was

cla

ssifi

ed in

to

6 m

odel

s:

1.

Com

mun

ity c

linic

s2.

Ex

chan

ge o

f let

ters

/rec

ord

shee

ts3.

li

aiso

n be

twee

n ho

spita

l tea

m

and

GP

4.

Com

pute

r ass

isted

shar

ed c

are

(GP

and

hosp

ital s

peci

alist

)5.

Sh

ared

car

e re

cord

car

ds (p

atie

nt

is gi

ven

book

lets

)6.

El

ectr

onic

mai

l (G

P an

d

hosp

ital s

peci

alist

)

◥

Taxo

nom

y off

ers c

hoic

e to

heal

thca

re w

orke

rs w

ishin

g to

in

tegr

ate/

deve

lop

shre

d ca

re

◥

Posit

ive:

shar

ed ca

re is

ap

prov

ed b

y pa

tient

s and

GPs

, ju

st as

effec

tive a

s out

-pat

ient

ca

re; c

ost-e

ffect

ive;

patie

nts

rece

ive s

peci

aliz

ed ad

vice


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S8

Kel

ly, B

., Per

kins

, d.A

., Ful

ler,

J.d.,

Park

er, S

.m. (

2011

). Sh

ared

car

e in

m

enta

l illn

ess:

A ra

pid

revi

ew to

in

form

impl

emen

tatio

n. In

tern

atio

nal

Jour

nal o

f Men

tal H

ealth

Sys

tem

s, 5(

31),

1-12

.

Rap

id R

evie

w

Exam

inin

g ev

iden

ce

of sh

ared

car

e m

odel

s of

am

bula

tory

men

tal

heal

th se

rvic

es

GEN

ERA

lSh

ared

Car

e m

enta

l Hea

lth

Effec

tive

shar

ed c

are

mod

els i

nclu

ded:

◥

Cro

ss o

rgan

izat

iona

l com

mitm

ent;

care

fully

des

igne

d an

d de

liver

ed

inte

rven

tions

; atte

ntio

n to

staff

tr

aini

ng a

nd se

lect

ion;

link

s acr

oss

serv

ice

leve

ls; c

linic

al m

onito

ring

, ag

reed

trea

tmen

t pro

toco

ls;

com

preh

ensiv

e se

rvic

es

* dep

ends

on

clin

ical

setti

ng

◥

Posit

ive:

impr

oved

soci

al

func

tion,

self-

man

agem

ent

skill

s, se

rvic

e ac

cept

abili

ty

redu

ced

hosp

italiz

atio

n,

impr

oved

acc

ess t

o sp

ecia

list

care

, bet

ter e

ngag

emen

t an

d ac

cept

abili

ty o

f men

tal

heal

th se

rvic

es

◥Si

gnifi

cant

set-

up c

osts

, re

duce

d pa

tient

cos

ts, s

ervi

ce

savi

ngs i

n th

e lo

ng-r

un9

law

n, S

. & l

awto

n, K

. (20

11).

Chr

onic

co

nditi

on se

lf-m

anag

emen

t sup

port

w

ithin

a re

spira

tory

nur

sing

serv

ice.

Jour

nal o

f Nur

sing a

nd H

ealth

care

of

Chro

nic I

llnes

s, 3,

372-

380.

Eval

uativ

e St

udy

Exam

inin

g an

inno

vativ

e ch

roni

c co

nditi

on

self-

man

agem

ent

supp

ort p

rogr

amm

e

AuST

RAlI

ASh

ared

Car

e

Chr

onic

Obs

truc

tive P

ulm

onar

y d

iseas

e

◥

Nur

ses p

laye

d a

cent

ral r

ole i

n cr

eatin

g a

mor

e coo

rdin

ated

serv

ice

for p

atie

nts w

ith C

OPd

acr

oss t

he

inpa

tient

/com

mun

ity co

ntin

uum

◥

mod

el b

roug

ht to

geth

er tw

o re

spira

tory

nur

ses (

RNs)

and

on

e Re

spira

tory

Chr

onic

dis

ease

N

urse

(RC

dN

)

◥G

oal w

as to

incr

ease

pat

ient

se

lf-m

anag

emen

t tec

hniq

ues a

nd

educ

atio

n on

resp

irato

ry co

nditi

ons,

devi

ses,

at-h

ome o

xyge

n us

e, (r

espi

rato

ry n

urse

s dea

ling

with

m

ore c

ompl

ex ca

ses,

and

RCd

Ns

with

less

com

plex

one

s)

◥

Impr

oved

pat

ient

ed

ucat

ion

(mor

e pa

tient

s un

ders

tand

ing

wha

t to

do w

hen

an e

xace

rbat

ion

occu

rs, n

ot a

lway

s nec

essa

ry

to a

dmit

ones

elf t

o ho

spita

l or

use

thei

r em

erge

ncy

pack

; dev

elop

men

t of b

ette

r in

form

atio

n sh

eets

◥

Stud

y sh

owed

a la

ck

of c

omm

unity

pro

vide

rs

prac

tisin

g ch

roni

c di

seas

e su

ppor

t; ba

rrie

r for

full

inte

grat

ion

of c

hron

ic c

are

into

the

com

mun

ity

as p

lann

ed


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S10

mac

leod

, A., B

ranc

h, A

., Cas

sidy,

J., m

cdon

ald,

A., m

oham

med

, N.

& m

a cd

o nal

d, l

. (20

07).

A n

urse

-/ph

arm

acy-

led

cape

cita

bine

clin

ic

for c

olor

ecta

l can

cer:

Resu

lts o

f a

pros

pect

ive

audi

t and

retr

ospe

ctiv

e su

rvey

of p

atie

nt e

xper

ienc

es. J

ourn

al

of O

ncol

ogy

Nur

sing,

11, 2

47-2

54.

Pros

pect

ive A

udit

and

Retr

ospe

ctiv

e Su

rvey

Redu

cing

toxi

citie

s in

colo

rect

al c

ance

r pat

ient

s th

roug

h ed

ucat

ion

an

d su

ppor

t

uN

ITEd

K

ING

dO

mSh

ared

Car

e

Col

orec

tal C

ance

r

Nur

se-P

harm

acy

◥

Patie

nts w

ere s

een

by ei

ther

the

nurs

e or t

he p

harm

acist

; wer

e pr

ovid

ed v

erba

l/writ

ten

info

rmat

ion

rega

rdin

g do

sage

s, sid

e effe

cts,

stora

ge, fo

od/d

rug

inte

ract

ions

◥

Emph

asis

on e

duca

tion

and

patie

nts b

eing

abl

e to

reco

gniz

e gr

ade

2 to

xici

ties i

n th

erap

y

◥

All

of th

e pa

tient

s who

re

spon

ded

in th

e st

udy

repo

rted

satis

fact

ion

◥

Satis

fied

with

trea

tmen

t ex

plan

atio

ns a

nd

clin

ic e

xper

ienc

e

11m

cCan

n, T

.v. &

Bak

er, H

. (20

03).

mod

els o

f men

tal h

ealth

nur

se–

gene

ral p

ract

ition

er li

aiso

n:

prom

otin

g co

ntin

uity

of c

are.

Jour

nal

of A

dvan

ced

Nur

sing,

41(5

), 47

1–47

9.

Qua

litat

ive

Stud

y

Iden

tify

mod

els o

f GP

colla

bora

tion

and

men

tal

heal

th n

urse

s

AuST

RAlI

ASh

ared

Car

e

men

tal H

ealth

GP

and

Nur

se

◥

Shar

ed C

are

mod

el: N

urse

m

aint

ains

clo

se c

onta

ct w

ith

GP

(Gen

eral

Pra

ctiti

oner

) and

is

the

case

man

ager

; dec

ision

s ar

e m

ade

join

tly

◥Sp

ecia

list l

iais

on m

odel

: C

omm

unity

men

tal h

ealth

team

as

sum

es o

vera

ll re

spon

sibili

ty o

f ca

re a

nd tr

eatm

ent,

cont

act w

ith

GP

is in

term

itten

t

◥

Shar

ed c

are

mod

el

is m

ore

cons

isten

t with

su

ppor

ting

pers

onal

an

d or

gani

zatio

nal

cont

inui

ty o

f car

e;

Spec

ialis

t mod

el li

mite

d

to p

erso

nal c

ontin

uity

12Re

tchi

n, S

.m. (

2008

). A

con

cept

ual

fram

ewor

k fo

r int

erpr

ofes

siona

l an

d co

-man

aged

car

e. Ac

adem

ic

Med

icin

e, 83

(10)

, 929

-933

.

Con

cept

ual F

ram

ewor

k

Impl

icat

ions

of I

P ca

re

mod

els o

n pr

actic

e an

d cu

rric

ula

chan

ges

uN

ITEd

ST

ATES

Shar

ed C

are

Prim

ary

Car

e –

Ger

iatr

ics,

m

enta

l Hea

lth

◥

Co-

man

aged

car

e sy

stem

; NP

or

phys

icia

n as

sista

nt c

o-m

anag

e th

e ca

re a

nd c

ondi

tion

of th

e pa

tient

◥

less

bur

den

on th

e ph

ysic

ian

◥

Redu

ces r

edun

danc

y of

task

s

◥le

ss fr

agm

enta

tion

in

patie

nt c

are


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ShA

red

CA

re

mo

del

S13

Scie

nce-

In-B

rief

. (20

11).

Syno

psis:

co

mm

unity

out

reac

h an

d ca

rdio

vasc

ular

hea

lth (C

OA

CH

) tri

al.

Syno

psis

of th

e C

OA

CH

Tr

ial (

Com

mun

ity

Out

reac

h an

d C

ardi

ovas

cula

r Tri

al)

uN

ITEd

ST

ATES

Shar

ed C

are

Chr

onic

dis

ease

man

agem

ent

◥

Nur

se p

ract

ition

er a

nd

com

mun

ity h

ealth

wor

ker

wor

k to

geth

er –

CO

AC

H

mod

el, t

o co

ntro

l cho

lest

erol

/BP

man

agem

ent o

f pat

ient

s

◥

und

erse

rved

pop

ulat

ions

be

nefit

from

this

mod

el;

mut

ual g

oal-s

ettin

g;

shar

ed d

ecisi

on- m

akin

g;

enco

urag

ed se

lf-m

onito

ring

an

d tr

acki

ng o

f pro

gres

s

14w

ilson

, C. (

2009

). N

urse

-man

aged

Fr

ee C

linic

Fos

ters

Car

e C

onne

ctio

n fo

r Hom

eles

s Pop

ulat

ion.

Re

habi

litat

ion

Nur

sing,

34(3

), 10

5-9.

Qua

litat

ive

Stud

y

Twel

ve y

ears

of

obse

rvat

ions

at a

nur

se-

man

aged

hea

lth c

entr

e; im

prov

ing

care

del

iver

y fo

r dis

enfr

anch

ised

po

pula

tions

uN

ITEd

ST

ATES

Shar

ed C

are

Add

ictio

n/Re

habi

litat

ion

◥

Nur

se an

d so

cial

wor

ker –

exam

ples

of

nur

se-m

anag

ed cl

inic

s

◥N

urse

pro

vide

s psy

chia

tric

as

sess

men

ts, c

ouns

ellin

g, H

Iv/T

B te

stin

g, h

ealth

edu

catio

n ad

dict

ion

and

soci

al se

rvic

es

◥Fo

cus o

n de

velo

ping

col

labo

rativ

e re

latio

nshi

ps b

etw

een

nurs

es

and

patie

nts

◥

very

pop

ular

clin

ic; 4

,000

en

coun

ters

per

yea

r/38

0 pe

ople

per

mon

th

◥N

egat

ive

to p

ositi

ve

perc

eptio

ns o

f hom

eles

snes

s du

e to

one

-one

inte

ract

ions

by

car

e pr

ovid

ers


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l1

Barlo

w, J.

, wri

ght,

C., S

heas

by, J

., Tu

rner

, A., &

Hai

nsw

orth

, J. (

2002

). Se

lf-m

anag

emen

t app

roac

hes f

or

peop

le w

ith c

hron

ic c

ondi

tions

: a

revi

ew. P

atie

nt E

duca

tion

and

Coun

selli

ng, 4

8, 1

77-1

87.

lite

ratu

re R

evie

w

Ove

rvie

w o

f se

lf-m

anag

emen

t ap

proa

ches

for p

erso

ns

with

chr

onic

con

ditio

ns

GEN

ERA

lo

t her

Chr

onic

Con

ditio

ns

Self-

man

agem

ent A

ppro

ache

s

◥

Gro

up ap

proa

ch: c

ombi

natio

n of

gr

oup/

indi

vidu

al co

unse

lling

with

a

nurs

e, te

lepho

ne ch

ats,

cons

ulta

tions

, ta

ke-h

ome m

ater

ials

such

as m

ovie

s, bo

oklet

s, au

dio

tape

s

◥In

divi

dual

app

roac

h: o

ne-o

n-on

e se

ssio

ns w

ith a

nur

se, t

ake-

hom

e m

ater

ials

to st

udy/

read

◥

Com

bina

tion:

indi

vidu

al

sess

ions

, gro

up se

ssio

ns, t

ake-

hom

e w

ork/

mat

eria

ls

◥

mul

ti-co

mpo

nent

pro

gram

s ar

e con

sider

ed th

e ‘’b

est

pack

age’’

for s

elf-m

anag

emen

t

◥Be

nefit

s to

patie

nts i

nclu

de

know

ledg

e-ga

in, b

ehav

iour

al

impr

ovem

ents

in se

lf-effi

cacy

and

ove

rall

heal

th

2Bo

denh

eim

er, T

., lo r

ig, K

., Hol

man

, H

., & G

rum

bach

, K. 2

002.

Pat

ient

Se

lf-m

anag

emen

t of C

hron

ic

dis

ease

in P

rim

ary

Car

e. Jo

urna

l of

the A

mer

ican

Med

ical

Ass

ocia

tion,

28

8(19

), 24

69-2

475.

Com

para

tive

Stud

y

The d

iffer

ence

bet

wee

n co

llabo

rativ

e car

e and

self-

man

agem

ent e

duca

tion

uN

ITEd

ST

ATES

Self-

man

agem

ent

Prim

ary

Car

e –

Chr

onic

dis

ease

◥

Stro

ng fo

cus o

n pa

tient

edu

catio

n;

prov

idin

g a

plan

that

allo

ws

patie

nt to

pro

blem

-sol

ve th

eir

chro

nic

cond

ition

◥

Impr

oved

pat

ient

self-

effica

cy

impr

oves

clin

ical

out

com

es

◥Pa

tient

bec

omes

mor

e in

depe

nden

t and

empo

wer

ed;

know

ledg

e to

iden

tify

and

solv

e chr

onic

issu

es

◥A

pply

pro

blem

-sol

ving

te

chni

ques

to 3

are

as o

f pa

tient

’s lif

e: m

edic

al,

soci

al, e

mot

iona

l3

Bons

al, K

., & C

heat

er, F

.m. (

2008

). w

hat i

s the

impa

ct o

f adv

ance

d pr

imar

y ca

re n

ursin

g ro

les o

n pa

tient

s, nu

rses

, and

thei

r col

leag

ues –

A

liter

atur

e rev

iew.

Inte

rnat

iona

l Jou

rnal

of

Nur

sing S

tudi

es, 4

5, 10

90-1

102.

lite

ratu

re R

evie

w

Ass

essi

ng th

e im

pact

of

adv

ance

d pr

imar

y

care

nur

sing

role

s on

th

e pa

tient

s, nu

rses

, and

th

eir c

olle

ague

s

GEN

ERA

lVa

riou

s mod

els

Prim

ary

Car

e

◥

Adv

ance

d Pr

actic

e N

urse

pro

vide

s ‘’fi

rst c

onta

ct c

are’’

◥H

elps

with

dia

gnos

is, tr

eatm

ent,

refe

rral

s, he

alth

pro

mot

ion,

pr

even

tativ

e ca

re

◥

Patie

nts w

ho h

ave

nurs

es a

s th

eir fi

rst p

oint

of c

onta

ct

tend

to e

xper

ienc

e hi

gher

le

vels

of sa

tisfa

ctio

n


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l4

Can

adia

n N

urse

s Ass

ocia

tion.

(2

008)

. Adv

ance

d N

ursin

g Pr

actic

e: A

Nat

iona

l Fra

mew

ork.

Can

adia

n N

urse

s Ass

ocia

tion,

Otta

wa,

ON

. Av

aila

ble

at: w

ww.

can-

aiic

.ca.

Fram

ewor

k to

pro

mot

e a

com

mon

und

erst

andi

ng

of A

dvan

ced

Nur

sing

Prac

tice

(AN

P)

CA

NA

dA

oth

er

Nur

sing

Fram

ewor

k

Prim

ary

Car

e

◥

Onl

y tw

o A

dvan

ced

Nur

sing

Pr

actic

e ro

les a

re re

cogn

ized

in

Can

ada;

Clin

ical

Nur

se S

peci

alis

t, (p

rovi

de e

xper

t nur

sing

car

e fo

r sp

ecia

lized

pop

ulat

ions

, pro

mot

es

the

use

of e

vide

nce)

; and

Nur

se

Prac

titio

ner (

prov

ides

dir

ect c

are

focu

sing

on

heal

th p

rom

otio

n,

trea

tmen

t/m

anag

emen

t of

chro

nic

cond

ition

s, au

tono

my

to

diag

nose

, ord

er, i

nter

pret

test

s an

d pr

escr

ibe

med

icat

ions

)

◥

why

Adv

ance

d

Nur

sing

Prac

tice?

◥

Impr

oved

clie

nt o

utco

mes

; qu

ality

of l

ife, s

atisf

actio

n of

car

e, co

st e

ffici

ency

; d

ecre

ase

ER v

isits

; ER

stay

s; fe

wer

read

miss

ions

; allo

ws

nurs

es to

wor

k at

adv

ance

d le

vels

of c

linic

al p

ract

ice

5d

e G

uzm

an, A

., Cili

ska,

d.,

& d

iCen

so, A

. (20

10).

Nur

se

prac

titio

ner r

ole

impl

emen

tatio

n in

Ont

ario

pub

lic h

ealth

uni

ts.

Can

adia

n Jo

urna

l of P

ublic

Hea

lth,

101(

4), 3

09-3

13.

de s

crip

tive

Stud

y

How

to in

tegr

ate

NPs

in

to P

ublic

Hea

lth u

nits

, un

ders

tand

bar

rier

s, m

easu

re N

P sa

tisfa

ctio

n

CA

NA

dA

- O

NTA

RIO

oth

er

Publ

ic H

ealth

uni

ts (P

Hu

)

Prim

ary

Car

e

◥

Abo

ut 6

% o

f NPs

wor

king

in

Ont

ario

wor

k w

ith P

Hu

s

◥Re

spon

sibili

ties i

nclu

de

perf

orm

ing

diag

nost

ic te

sts,

inte

rpre

ting

the

test

s, pr

escr

ibin

g ph

arm

aceu

tical

s, m

onito

ring

m

anag

ing

chro

nic

dise

ases

, tr

eatin

g ac

ute,

min

or il

lnes

ses a

nd

perf

orm

ing

Pap

test

s if s

peci

fied

by th

e PH

u

◥

No

clin

ical

out

com

es

◥Su

rvey

reve

aled

that

ph

ysic

ians

and

hea

lth

prov

ider

s had

trou

ble

defin

ing

and

unde

rsta

ndin

g th

e nu

rse

prac

titio

ner r

ole;

la

ck o

f sta

ff to

supp

lem

ent

the

wor

k of

the

nurs

e pr

actit

ione

rs if

they

wer

e aw

ay; s

peci

alis

ts h

esita

nt

to ta

ke re

ferr

als f

rom

nu

rse

prac

titio

ners

◥

If n

urse

pra

ctiti

oner

s are

go

ing

to b

e a

perm

anen

t par

t of

pub

lic h

ealth

uni

ts, t

hen

impr

ovin

g ro

le in

tegr

atio

n th

roug

h ed

ucat

ion

and

trai

ning

is re

quire

d


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l6

diC

enso

, A., &

Bry

ant-

luko

sius,

d.

(201

0). Th

e lo

ng a

nd w

indi

ng R

oad:

In

tegr

atio

n of

Nur

se P

ract

ition

ers

and

Clin

ical

Nur

se S

peci

alist

s int

o th

e C

anad

ian

Hea

lthca

re S

yste

m.

CJRN

, 42(

2), 3

-8.

Edito

rial

CA

NA

dA

ot h

er –

rol

e d

e vel

opm

ent

◥

Spec

ial i

ssue

focu

sing

on

Can

adia

n ex

peri

ence

s – e

ach

pape

r rep

orts

par

t of a

bro

ader

sc

opin

g re

view

and

find

ings

from

ke

y in

form

ants

◥

No

outc

omes

7d

onal

d, F

., mar

tin-m

isen

er, R

., Br

yant

-luk

osiu

s, d

., Kilp

atri

ck, K

., K

aasa

lain

en, S

., & C

arte

r, N

. (20

10).

The

Prim

ary

Hea

lthca

re N

urse

Pr

actit

ione

r Rol

e in

Can

ada.

Nur

sing

Lead

ersh

ip, 2

3, 8

8-11

3.

lite

ratu

re R

evie

w

(Syn

thes

is)

dev

elop

a b

ette

r un

ders

tand

ing

of

Adv

ance

d N

ursin

g Pr

actic

e Ro

les

CA

NA

dA

- G

ENER

Al

oth

er

Role

of th

e PH

CN

P (P

rimar

y H

ealth

care

N

urse

Pra

ctiti

oner

) in

Can

ada

PHC

NPs

hav

e th

e au

thor

izat

ion

to

carr

y ou

t the

follo

win

g: m

ake

and

com

mun

icat

e a

diag

nosis

of d

isea

se;

orde

r and

inte

rpre

t dia

gnos

tic a

nd

scre

enin

g te

sts;

pres

crib

e m

edic

atio

ns

* In

Que

bec,

esta

blish

ing

a pr

imar

y di

agno

sis re

mai

n th

e ex

clus

ive

dom

ain

of th

e ph

ysic

ian

◥

Add

ed c

osts

and

in

effici

enci

es in

syst

em

deliv

ery

whe

n nu

rse

prac

titio

ners

wai

t for

ph

ysic

ians

to si

gn a

pr

escr

iptio

n or

requ

est a

test

8El

-Jard

ali, F

., & l

avis,

J.N

. (20

11).

Add

ress

ing

the I

nteg

ratio

n of

Nur

se

Prac

titio

ners

in P

rimar

y H

ealth

care

Se

tting

s in

Can

ada.

Ham

ilton

, Can

ada:

M

cMas

ter H

ealth

For

um, 1

-30.

Repo

rt –

Issu

e Br

ief

CA

NA

dA

oth

er

◥

Prob

lem

: chr

onic

dis

ease

m

anag

emen

t; op

timal

use

of

nur

se p

ract

ition

ers

◥

laun

ch m

ulti-

stak

ehol

der p

lann

ing

initi

ativ

e to

addr

ess i

ssue

of

inte

grat

ion

of n

urse

pra

ctiti

oner

s in

PHC

setti

ngs i

n C

anad

a

◥Su

ppor

t con

siste

ncy

in

educ

atio

nal a

nd re

gula

tory

st

anda

rds,

requ

irem

ents

and

pr

oces

ses (

stan

dard

s) fo

r nur

se

prac

titio

ners

acr

oss t

he c

ount

ry

◥la

unch

info

rmat

ion/

educ

atio

n ca

mpa

ign

on in

nova

tion

s th

at

coul

d m

eet n

eeds

of p

atie

nts

in

prim

ary

care

◥

Bigg

est b

arrie

rs –

supp

ort o

f ph

ysic

ians

and

orga

nize

d m

edic

ine

◥

Not

app

licab

le


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l9

Hut

chis

on, B

., Abe

lson,

J., &

lav

is, J.

(2

011)

. Pri

mar

y C

are

in C

anad

a: S

o m

uch

Inno

vatio

n, S

o li

ttle

Cha

nge.

Hea

lth A

ffairs

, 20(

3), 1

16-1

31.

dis

cuss

ion

Pape

r

Focu

s on

polic

y

CA

NA

dA

oth

er

◥

Polic

ies c

reat

e pat

h de

pend

enci

es

that

are d

ifficu

lt to

shift

due

to co

st,

chan

ge re

quire

men

ts, s

uppo

rts

◥

Polic

ies:

fede

ral/p

rovi

ncia

l di

visio

n of

pow

ers;

priv

ate

prac

tice

but p

ublic

fund

ing

(FFS

, clin

ical

au

tono

my

and

cont

rol i

nclu

ding

lo

catio

n of

pra

ctic

es);

priv

ilegi

ng

phys

icia

ns a

nd h

ospi

tals

◥

Inno

vatio

ns

◥1s

t wav

e (19

70s)

– al

tern

ate

paym

ents

e.g. C

HC

s (gl

obal

), H

SO (c

apita

tion)

, CSl

C

(hyb

rid);

boar

ds (C

HC

s, C

SlC

)

◥2n

d w

ave (

mid

‘80s

) – su

ppor

t fo

r alte

rnat

e non

-phy

sicia

n pr

ovid

ers i

n pr

imar

y ca

re

(mid

wiv

es, N

Ps) –

resu

lts

not u

ntil

‘90s

◥

3rd

wav

e (m

id ‘9

0s) –

refo

rm;

dem

onst

ratio

n pr

ojec

ts

◥

less

ons

◥

Big

bang

or t

rans

form

atio

n m

ay n

ot b

e po

ssib

le

◥A

ccep

t a p

lura

lism

of m

odel

s

◥Bl

ende

d fu

ndin

g m

odel

s –

addr

esse

s iss

ue o

f res

istan

ce

◥N

eed

for s

igni

fican

t in

vest

men

ts in

pri

mar

y ca

re


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l10

Ken

dall,

S., w

ilson

, P., P

roct

er, S

., Br

ooks

, F., B

unn,

F., G

age,

H., &

m

cNei

lly, E

. (20

10).

The N

ursin

g Co

ntrib

utio

n to

Chr

onic

Dise

ase

Man

agem

ent:

A W

hole

Sys

tem

s Ap

proa

ch. N

atio

nal I

nstit

ute

for

Hea

lth R

esea

rch-

SdO

Pro

ject

, 1-7

.

Eval

uativ

e C

ase

Stud

y

Expl

ore,

iden

tify

and

char

acte

rize

effe

ctiv

e C

hron

ic d

isea

se

man

agem

ent m

odel

s

uN

ITEd

K

ING

dO

mVa

riou

s mod

els

Chr

onic

dis

ease

man

agem

ent

(who

le S

yste

ms A

ppro

ach,

Pub

lic

Hea

lth m

odel

, Pri

mar

y C

are

mod

el,

Com

mun

ity m

atro

ns m

odel

)

Who

le s

yste

ms a

ppro

ach:

Bas

ed o

n ch

roni

c di

seas

e m

anag

emen

t mod

el

(cau

sal s

yste

ms,

data

syst

ems,

patie

nt

expe

rien

ce)

Publ

ic H

ealth

: Sch

ool n

urse

s pro

vide

a

visio

n fo

r ast

hma

care

; foc

us o

n aw

aren

ess a

nd p

reve

ntio

n

Prim

ary

ca r

e Mod

el: G

ener

al

prac

titio

ner p

rovi

des c

are a

nd fo

llow

up

Nur

se s

peci

alis

t Mod

el: F

ocus

es o

n se

lf-m

anag

emen

t

co m

mun

ity M

atro

n M

odel

: Top

-dow

n ap

proa

ch, fi

rst p

oint

of c

onta

ct

◥

Spec

ialis

t mod

els

redu

ce h

ospi

taliz

atio

ns

and

read

miss

ions

◥

Furt

her e

duca

tion

of th

e pu

blic

is re

quire

d; c

hang

ing

perc

eptio

ns o

f tra

ditio

nal

nurs

ing

role

s and

scop

e


#r

efer

ence

(alp

habe

tical

)ty

pe o

f rep

ort/

Pape

rlo

catio

nd

escr

iptio

n of

Mod

elo

utco

mes

ot

her

mo

del

S o

r P

APe

rS

rel

Ated

to

mo

del

S IN

geN

erA

l11

Kor

en, I

., mia

n, O

., & R

ukho

lm,

E. (2

010)

. Int

egra

tion

of N

urse

Pr

actit

ione

rs in

to O

ntar

io’s

Prim

ary

Hea

lthca

re S

yste

m: v

a ria

tions

Acr

oss

Prac

tice

Setti

ngs.

CJN

R, 4

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aPPenDIX c: case sTUDY – InTeRPRofessIonal MoDel of caReAlberta Primary Care Network (PCN)

headline: do you know what your nurses at the Primary Care Network can do for you?

The Challenge: Why establish Primary Care Networks?

Primary Care Networks (PCNs) in Alberta have been established in response to a number of concerns.

◥ many Albertans do not have access to primary care. ◥ There are increasing demands for effective management of chronic diseases, such as diabetes, as

well as a need for strategies to manage complex needs of patients with multiple diagnoses, poverty, substance abuse, and challenging family relationships.

◥ Primary care nursing roles are not fully optimized to meet the needs of the population. ◥ There is a need to address the comprehensive needs of patients, including a focus on the social

determinants of health.

Potential benefits of PCNs

It is anticipated that PCNs, when successfully implemented, will:

◥ Increase Albertans’ access to primary care. ◥ Improve interprofessional collaboration. ◥ Improve coordination of primary care with other healthcare sectors. ◥ Improve care through proactive planning and links to supports (housing, nutrition and comprehensive

care) in a timely manner. ◥ Increase emphasis on health promotion, disease and injury prevention, and attention to chronic

disease management. ◥ Reduce hospitalization. ◥ Help the patient navigate through the health and social systems, so that they don’t fall through

health system gaps.

About Primary Care Networks: history, purpose and scope

◥ PCNs are funded by the Alberta provincial government through its Primary Care Initiative. under the PCN model, groups of family physicians in local communities come together and voluntarily partner with Alberta Health Services to establish a PCN.

◥ The physicians receive $50 per patient, per year, from Alberta Health and wellness (AHw). Physicians also continue to receive fee-for-service or other payments through alternate payment mechanisms.

◥ The per-capita funds can be used to hire nurses and other healthcare providers, and also to provide patient education or other programs. under the model, family physicians, family health nurses and other health professionals work together as a multi-disciplinary team.

◥ The Primary Care Initiative was initially established in 2003, led by three organizations: Alberta Health Services (previously Alberta Regional Health Authorities); the Alberta medical Association; and Alberta Health and wellness (government department). A central Project management Office


(PmO) was established to assist interested groups of physicians in submitting their letters of intent. ◥ A detailed set of tools was developed to support the development of the PCNs. For example,

once a letter of intent was reviewed and approved by the Primary Care Initiative, the PmO team worked closely with the applicant group to develop operational and business plans. An important component of the planning and implementation process was to ensure that the PCN reflected local needs, context and partners.

The role of nurses in PCNs

Nurses play generalist and specialist roles in PCNs. As an example, here are some of the roles undertaken by nurses at the Red deer PCN.

◥ Family nurses who are registered nurses provide counseling, patient education and navigation support. The PCN offers diabetes education, education related to high blood pressure, and education for moms and new moms.

◥ doctors refer patients to the family nurse. The family nurse contacts the patient by phone and arranges appointments.

◥ Nurse practitioners run a Street Nurse Clinic, three days a week (with or without appointments), to serve the needs of vulnerable people in the downtown core. The nurse practitioner helps to provide essential healthcare services to people who may otherwise not have ready access to these services. Examples of services include communicable disease control, wound care, testing for sexually transmitted disease, management of chronic conditions such as diabetes and high blood pressure, and access to required resources.

Nurse practitioners also have their own panel of patients in PCNs, but with specific restrictions.

◥ Patients cannot have been seen by a family physician within a 36-month period. ◥ Patients cannot be already assigned to a PCN physician. ◥ The care provided by the nurse practitioner needs to be considered comprehensive. Examples of this

comprehensive care can include ordering and interpreting routine screening for all ages according to appropriate guidelines; diagnosing, ordering tests and prescribing treatments and medications for primary care patient populations (from birth throughout the life cycle) as authorized through legislation; working independently yet in a collaborative manner with PCN core physicians (managing patients with chronic conditions and mental health issues as part of his/her practice, for example); and responding to requests for routine episodic care needed by the patient population.

◥ The nurse practitioner needs to have a current “Nurse Practitioner – Family/All Ages” Practice Permit with the College and Association of Registered Nurses of Alberta.

◥ The nurse practitioner needs to submit (or start submitting) shadow billings to AHw.

development and implementation of the PCN model

◥ Forty (40) PCNs have been implemented between 2005 and 2012, with over 2,500 physicians participating. ◥ depending on the needs of the community, PCNs have developed different programs–palliative

care, for example. ◥ many different models of PCNs currently exist (within the parameters of a provincial framework).

For example, a PCN can be one clinic or have several clinics with different configurations of physicians,


nurses and other staff. The model is determined at the local level with input from local community stakeholders. This means that no two PCNs are the same.

evaluation of the PCN initiative

Each PCN is expected to conduct its own evaluation. However, an evaluation of PCNs across the province was conducted between 2009 and 2011 by a private consulting firm contracted by the oversight bodies. The evaluation involved both a formative and summative evaluation. details of the evaluation methods are not available.

evaluation results

The evaluation findings were as follows:

◥ There has been a marked increase in the number of Albertans now attached to a family physician. ◥ PCN physicians have more time to spend with patients. ◥ Increased patient access to primary care is a priority for almost all PCNs. ◥ There has been improved access to primary care, including access to some specialized services

within the primary care setting. ◥ PCNs have developed linkages within Alberta Health Services and external agencies and providers,

most notably 100% with home care; 90% with community mental health and community health services; and 84% with public health, hospitals, emergency departments, and physician specialists.

◥ Expanding the multi-disciplinary teams has been a key priority for most PCNs. ◥ multi-disciplinary teams continue to be well-functioning units within PCNs. ◥ members of multi-disciplinary teams work to their full scope of practice in PCNs. ◥ There has been less utilization of emergency rooms by PCN patients. ◥ Targeting complex patients and/or patients with chronic disease is a priority in most PCNs. ◥ There is increased patient access to chronic disease management. ◥ Patients are informed of after-hours care alternatives. ◥ PCN physicians (compared with non-PCN physicians) more commonly screen for smoking

(93% vs. 77%); tetanus/diphtheria immunization (59% vs. 33%); clinical breast exam (99% vs. 84%); mammography (96% vs. 85%);and bone density (63% vs. 44%).

◥ PCN patients report greater satisfaction with regard to wait times. ◥ 96% of PCN physicians have changed how they practice. ◥ PCNs have contributed to the retention of family physicians.

looking ahead

◥ Nurses in PCNs need to continue to develop professional independence from physicians. ◥ The fee-for-service compensation model for physicians is not conducive to collaborative practice. ◥ Nurses have high workload and a high demand for their time, but are not working within their


full scope of practice. ◥ There are inadequate training opportunities for nurses working in primary care.

references

1. Building a primary care network. Available at: www.albertapci.ca. 2. ludwick, d.A. (2011). Primary Care Networks: Alberta’s primary care experiment is a success –

now what? Healthcare Quarterly, 14(4), 7-8.3. manns, B.J., Tonelli, m., Zhang, J., Campbell, d.J.T., Johnson, J., Sargious, P., et al. (2011). The

impact of primary care networks on the care and outcomes of patients with diabetes. Report to Alberta Health and wellness and Alberta Health Services. Available at: Interdisciplinary Chronic disease Collaboration (www.ICdC.ca).

4. Primary Care Initiative (PCI). Supporting Primary Care Networks. Available at: www.albertapci.ca. 5. white, P.J. (2011). The President’s letter. Alberta medical Association. Available at: www.albertadoctors.org.


aPPenDIX D: case sTUDY – InTeRPRofessIonal MoDel of caReCentre Local de Services Communautaires (Local Community Service Centres): The CLSC Model of Care

headline: Adopting the local Community Service Centre (ClSC) Solution

The Challenge: Why establish ClSCs?

◥ In the 1960s, Quebec recognized that it needed to modernize, redevelop, and expand its social and educational systems; prior to Quebec’s 1960s “quiet revolution,” all education, health and social services had been funded by the government, but remained under the patronage of the Roman Catholic Church.

◥ There was a need for greater responsiveness to the needs of local communities in the area of health and social services.

Potential benefits of ClSCs

It is anticipated that ClSCs, when successfully implemented, will:

◥ Provide preventive and curative health services to vulnerable groups (perinatality, senior citizens, youth, mental health, disabled).

◥ Enhance the social well-being of the population with a comprehensive (front-line) and community approach, bridging individual and community experiences, know-how and expertise.

◥ Allow individuals to confront problems and solutions autonomously. This means involving clients in the decision-making process and ensuring that the information passed on from healthcare workers to patients is well comprehended.

◥ Improve communication and collaboration between medical staff in the areas of patient referrals and follow-ups.

◥ Forge stronger partnerships with community pharmacies, community organizations, university hospitals, clinics, rehabilitation centres and newer entities such as GmFs (Family medicine Groups) and the CSSSs.

About ClSCs: history, purpose and scope

◥ The context in which the government of Quebec launched the ClSCs was a holistic one. The aim was to provide alternative non-private healthcare facilities comprising both preventive and social services, whereby residents and visiting persons in need of health and social services would be able to access the care that they required in a timely, affordable, and supportive way.

◥ ClSCs were first established in Quebec in 1972 as outlined by the Castonguay-Nepveu Commission. At the time, it was the only model of its kind in Canada. The idea was to provide a range of healthcare services in a single location within a community-sponsored governing body.

◥ The ClSC runs under a provincially planned regional network and its services are defined by provincial statutes. Each ClSC has an elected board composed of internal and external members (providers, centre users, community residents).


◥ ClSCs fall under the jurisdiction of the provincial government’s ministry of Social Affairs, which is also the governing body from which it receives its funding. Funding is usually based on needs and is allocated according to the population of an area, not users of the centre.

◥ ClSCs are responsible for the individuals in their catchment area. users of the centre have access to multiple service providers – doctors, social workers, homecare workers, and others.

◥ ClSCs provide various services including health services (walk-in clinics); primary social services; integrated health and social services (home, school, mother-child); prevention services (lifestyle education, self-help); and community organization services (programs for specific groups such as women in need, mental health, alcohol and addiction).

The role of nurses in the ClSCs

◥ Nurses play a central role in ClSCs including telephone follow-ups, at-home visits, (within 48 hours for a post-natal follow-up), physician referrals for special problems, referrals for psycho-social support workers, and return visits to ClSCs.

◥ The work of nurses also encompasses patient education and monitoring, which includes health promotion and encouraging patients to be more proactive in their own health through preventive measures, lifestyle changes, and self-care management.

◥ Examples of nurse-led assistance include arranging medical consultations, carrying out vaccinations, and performing screenings, post-surgery treatments and diagnostic tests (pregnancy, blood, glucose).

development and implementation of the ClSC model

◥ 1st Phase: ClSCs were initially launched in 1972. By 1975, there were 50 active ClSCs across the province, all oriented towards prevention, participation, and local autonomy.

◥ 2nd Phase: Between 1976 and 1978, in order to control government spending and cost increases related to inpatient care, the focus was changed to that of expanding and strengthening external care services. ClSCs adopted general social services and CSSs (Centres of Social Services) absorbed specialized social services, with a plan for CSSs to transfer staff members to ClSCs. The planned transfer was delayed due to institutional resistance; implementation took place in 1984.

◥ 3rd Phase: Between 1979 and 1985, ClSCs received a new mandates: home, school, and child services; primary social service; and occupational health services. An evaluation commissioned by the ministry of Health and Social Services (the Brunet Report) was carried out to assess the performance of ClSCs.

◥ By the mid-1990s, there were 160 ClSCs across Quebec employing over 16,000 staff and 1,200 doctors, of which 95% were on salary and did not follow FFS (Fee for Service) practices.

◥ To improve Québec’s Primary Healthcare System and enhance collaboration, coordination and access to care, the CSSSs (Centres of Health and Social Services) model was designed in 2003 to encompass hospitals, community health centres, ClSCs (local community centres), CSSs (Centres of Social Services), and long-term care homes.

◥ CSSSs were established for stakeholders to provide health and social services under one agency, as ClSCs can support an even distribution of health and social personnel (physicians, nurses, nutritionists, dentists, lab technicians, social workers, domestic aids, psychologists, community workers, and others). This network of health centres and social service groups led to the establishment of 95 CSSSs throughout the province.


◥ CSSSs act as a hub to provide both general and specialized services, and refer individuals to ClSCs and available health services in their area.

◥ CSSSs host public, not-for-profit contracted and private health centres (private hospitals, nursing homes).

evaluation of ClSCs

◥ In 1975, the Bilan report was commissioned to help classify the first groupings of ClSCs based on their adoptive approach of programs. The Bilan report was the first evaluation of the ClSCs.

◥ In 1980, marc Renaud carried out a tension headache simulation study, where his graduate students were sent to fee-for-service and to ClSC centres for the same health conditions. The goal of the study was to assess GPs (general practitioners) working in different practice settings in the montreal area.

◥ In 1983, Renaldo Battista and walter Spitzer carried out a study on adult prevention care, comparing different primary care settings in Quebec, including ClSCs.

◥ In 1987, the Quebec minister of the department of Health and Social Services commissioned a study (widely known as the Brunet Report) to evaluate the current state of the 150 ClSCs in Quebec, and to make recommendations for their future.

◥ In 2002, Sicotte et al. evaluated 150 Community Health Care Centres (CHCCs) in Québec by conducting an empirical research study. The purpose of the study was to measure the intensity of interprofessional collaboration among CHCCs.

evaluation results

◥ The 1975 Bilan report revealed that the ClSCs could be categorized in three ways: service-oriented model, community development model, or mixed model approach.

◥ This led to various important recommendations, 24 in total, several of which are now part of the ClSC mandate. As a result of these recommendations:

◥ ClCSs now follow a mixed model approach. ◥ ClSCs are small institutions close to the populations that they serve. ◥ Staff are compensated by salary. ◥ Facilities provide accessible services that are public and private. ◥ Regional councils of health services and social services have responsibility for general

coordination of services provided in their territory. ◥ marc Renaud’s tension headache simulation study revealed that private practice doctors were more

likely to prescribe ‘’inadequate therapies.’’ ClSC doctors imposed stricter time limits on prescription drugs, offered explicit warnings on chronic drug use, and provided information on alternative treatment methods. The examination time was more thorough at the ClSC, and the ClSC physicians were more complete in investigating the cause and nature of the headaches as well as the patient’s medical history. This approach promoted a supportive relationship with the patient.

◥ Renaldo Battista’s and walter Spitzer’s study revealed that ClSC physicians tended to uphold the recommended notions for preventive practice, and were more keen to pursue prevention when examining patient-physician encounters. The authors of this report have suggested that this is because ClSCs and Family medical Groups are multidisciplinary, include more allied health professionals, and provide more preventive kits and information pamphlets on health issues, whereas the fee-for-service payment model does not adequately compensate preventive activities in private practice.


◥ The 1987 Brunet Report revealed differences in the status of health between different economic and ethnic groups. The report also identified a number of difficulties faced by ClSCs, including:

◥ resistance from social service organizations and public health service to give ClSCs the resources they need

◥ lack of clear policy directions from the ministry of Health and Social Affairs ◥ evidence from ClSC management boards that they had difficulties in understanding their

mission; and ◥ issues with unions. (unions encouraged staff members who were sympathetic with their views

to be elected to ClSC boards.) ◥ The Brunet report outlined the following recommendations:

1) Establish a common level of service among all ClSCs. 2) Put emphasis on early detection and first-line treatment of medical and psychological

problems with appropriate referrals. 3) Expand the home care program.4) Establish four program areas for “groups at risk:” infants and families; youth in difficulty;

adults with mental health problems; and one other group at risk, selected by the ClSC, that has importance in the area it serves.

5) limit the activities of the community action component to avoid duplication with the work of other government services.

◥ The Sicotte et al. empirical research study produced modest results. It found that interprofessional collaboration was taking place, but that it was limited by internal working group dynamics. Professionals worked in monopolies to protect their fields of expertise and felt threatened in interprofessional environments, resulting in tension between disciplinary and interdisciplinary logics. The report recommended realigning professional training programs so that mixed, rather than like, professionals were receiving interprofessional education side by side, in order to foster more collaboration and collaborative relationships across different professional groups.

looking ahead

ClSC challenges include:

◥ expanding and meeting the 200-centre target due to lack of government support and opposition from the medical field; and

◥ attracting physicians to work in ClSCs where salaries are well below fee-for-service averages of physicians in private practices.

references

1. Battista, R., & Spitzer, w. (1983). “Adult Cancer Prevention in Primary Care: Contrasts Among Primary Care Practice Settings in Quebec” in the American Journal of Public Health, 73,(9).

2. Bozzini, l. (1988). local Community Service Centres in Quebec: description, Evaluation, Perspectives. Journal of Public Health Policy, 9(3), 346-375.

3. Cawley, R. (1996). The Incomplete Revolution: The development of Community work in Quebec ClSCs. Community Development Journal, 31(1), pg. 54-65.


4. Centre de santé et de services sociaux, la Pommeraie. (2008). list of Services : Nursing Care at the ClSC. Gouvernement du Québec. Retrieved from: www.santemonteregie.qc.ca/lapommeraie/services/ser/fiche/infirmiersg.en.html.

5. Centre de santé et de services sociaux de Gatineau. (2012). mission, vision, values. Retrieved from: http://www.csssgatineau.qc.ca/en/our_organization/mission_vision_ values/.

6. CuPE. (1996). Community Health Centres: Primary Care Providers Performance Re Health Promotion and Illness Prevention. Retrieved from: http://cupe.ca/primary-health-care/community-health-centres.

7. Gaumer, B., & desrosier, G. (2004). l`Histoire des ClSC au Québec : Reflet des contradictions et des luttes a lìntérieur du système. Ruptures, revue transdisciplinaire en santé, 10(1), 52-70.

8. Health Index: The Quebec Health directory. (2007-2012). The network of health centres and social services in Quebec. Retrieved from: http://www.indexsante.ca/articles/ article-47.html.

9. lois et reglements du Quebec, c . S-s, s.l., art I. Aprili, I986.10. Renaud, m. (1980). Practice Settings and Prescribing Profiles: The Simulation of Tension

Headaches to General Practitioners working in different Practice Settings in the montreal Area. American Journal of Public Health, 70(10).

11. Sicotte C., dÀmour, d., & moreault, m.P. (2002). Interdisciplinary Collaboration within Québec Community Healthcare Centres. Social Science and Medicine, 55, 991-1003.


aPPenDIX e: case sTUDY – nURse-leD MoDel of caReNurse-Practitioner Led Clinic (NPLC) Model of Care in Sudbury, Ontario

headline: NP-led Clinics win hearts of many who have not had a primary care provider for years

The Challenge: Why establish Nurse Practitioner-led Clinics (NPlCs)?

NPlCs in have been established to address a number of concerns.

◥ There are thousands of Canadians who are “unattached” or labelled as “orphaned patients” – patients with no primary care physician.

◥ There is a chronic shortage of family physicians, particularly in pockets of urban, rural and remote communities.

◥ There is an increasing demand for chronic disease management, along with an increasing awareness of the benefits of routine preventive primary care and of the merits of interprofessional care.

◥ Across Canada, there is an aging population living with chronic health conditions in the community (their own homes). This population requires heath support, care coordination, and care management over a longer lifespan.

◥ members of the population who are disadvantaged or who have special needs have access issues that need to be addressed.

◥ Patients experience long delays in getting seen by a physician in primary care. ◥ The high use of emergency rooms for non-urgent or emergent health issues in hospitals creates

congestion and inefficiencies. ◥ There is a need for comprehensive and integrated primary healthcare. ◥ Healthcare costs are increasing, and all levels of government are aggressively searching for cost-cutting

measures and cost-effective solutions.

Potential benefits of NPlCs

It is anticipated that NPlCs, when successfully implemented, will:

◥ Increase access to primary care in a timely manner and close to home. ◥ Increase interprofessional collaborative care, whereby the scope of practice of each provider is

optimized in a cost-effective and efficient manner. ◥ Address complex healthcare issues such as those associated with chronic diseases, health

promotion and disease prevention through screening and monitoring. ◥ Improve health and social outcomes of target groups. ◥ Provide cost-effective healthcare solutions. ◥ Provide continuity of care. (By registering with the NPlC itself rather than with a specific provider,

patients remain with the clinic and receive consistent care even if the provider leaves the clinic.) ◥ Improve coordination of care through linking primary care with community-based prevention

programs, home care, and hospital-based care. ◥ use NPs appropriately to their full scope of practice.


About NPlCs: history, purpose and scope

◥ NPlCs are incorporated, not-for-profit entities with voluntary governing boards. ◥ The NPlCs are funded by the Ontario ministry of Health and long-Term Care and are supported

by various community groups or agencies, health organizations, academic institutions and other partners through in-kind support, expertise and sharing arrangements.

◥ Community-based programs at NPlCs are developed through a systematic process of community outreach, collaboration, needs assessment, planning, implementation and evaluation.

◥ Examples of programs provided by NPlCs include diabetes education sessions, smoking cessation, HPv immunization, and programs for weight-loss.

◥ under the NPCl model, physicians receive monthly stipends for consultations and fee-for-service for any appointments with patients.

◥ The first NPlC was started in Sudbury, Ontario in 2007 and served as the pilot. Successful acceptance, implementation and impact helped to build a case for an additional 25 NPlCs.

◥ NPlCs are located in areas of the province where there are shortages of physicians and many unattached patients as well as under-served populations. The Sudbury district NPlC model, for example, was built around the availability of qualified providers. In the case of Sudbury at the time the NPlC pilot model was introduced, there were eight unemployed nurse practitioners in the community. Some were working out of town or in the process of moving.

◥ In Sudbury, at the first NPlC, there are currently 5.5 nurse practitioners, two part-time physicians, a registered nurse, a pharmacist, a social worker, a dietitian, an office manager, and clerical staff. Two satellite clinics have been launched.

NPlCs are required to:

◥ Provide the same comprehensive family healthcare services that other models provide, using an interdisciplinary team of NPs, RNs, family physicians, and a range of other healthcare providers.

◥ Support their patients, through navigation and care coordination, to access care in other parts of the healthcare system as required, and connect them to community resources.

◥ Put emphasis on health promotion, illness prevention and early detection/diagnosis. ◥ develop and provide comprehensive community-based chronic disease management and

self-care programs. ◥ Involve the patient as a key member of the team and support the patient to make informed

decisions and manage his/her self-care needs. ◥ leverage information technology to support system integration by linking patient records across

different healthcare settings, ensuring timely access to diagnostic and other patient information.

The role of nurses at NPlCs

◥ Nurse practitioners at the NPlCs are salaried and paid by the ministry, as are other healthcare providers (except for physicians who work with them).

◥ Nurse practitioners provide comprehensive primary care with the ability to assess, diagnose, treat and monitor a range of health issues.

◥ Patients are registered with the clinic, but are assigned to a specific nurse practitioner.


development and implementation of the NPlC model

The NPlC model was developed through a number of activities that occurred at several different levels, and through many different stakeholder groups. These activities included political advocacy, policy development, community engagement, research, and program planning/implementation.

Nursing leadership and political action were provided by Roberta Heale and marilyn Butcher, two nurse practitioners who conceptualized and put voice to the idea of NPlCs. As well, lobbying efforts were made by the Registered Nurses’ Association of Ontario.

Calls for proposals to establish NPlCs were issued in three waves, with the goal of having all 26 NPlCs in place by the end of 2012. The proposals followed a standard template and required the following:

◥ A description of catchment area and specific communities targeted by the NPlC, including population characteristics and a health profile.

◥ A description of existing family healthcare services in the proposed catchment area/community. ◥ Identified gaps in family healthcare services in the proposed catchment area/community. ◥ A proposed governance model for the NPlC (each NPlC was required to form a separate and

distinct not-for-profit corporation). ◥ A list of nurse practitioners who would be affiliated with the NPlC, and their letters of commitment. ◥ A list of collaborating physicians and their letters of commitment. ◥ Statistics on the priority populations for the NPlC. (Potential patients had to be those who did

not have a regular family healthcare provider and who were experiencing difficulty accessing family healthcare services.)

◥ Examples of specific programs that would meet the needs of the defined priority populations. ◥ Examples of other programs such as capacity development (student placements, research program). ◥ The intention to register 800 patients per nurse practitioner once the NPlC was fully operational. ◥ A description of community partners. ◥ A description of one-time and/or on-going financial or other supports from each source. ◥ A description of readiness to operate (length of time that would be required to get to full

operation; availability of location; detailed work plan). ◥ Evidence of support of professional associations, regulatory bodies, government nursing leaders,

and/or ministry of Health champions.

An agreement was made between the NPlCs and the Nursing Secretariat, ministry of Health, with the intention that the agreement would eventually also include the local Health Integration Networks.

various parallel activities in the province helped to support and expand the focus on NPlCs and other nurse practitioner roles in other models and healthcare sectors. These included:

◥ The establishment of the Nurse Practitioners’ Association of Ontario, along with its networking and advocacy efforts

◥ Educational programs and legislative changes


◥ Attention to communication and collaboration between nurse practitioners and physicians and other health providers such as midwives, social workers and pharmacists

◥ mentorship of novice nurse practitioners by experienced nurse practitioners ◥ legislation that initially recognized nurse practitioners, and later, Bill 179, which removed

restrictions to nurse practitioners (prescribing medications, ordering laboratory and other diagnostic tests, admitting/discharging patients, and requiring all regulated healthcare providers to carry liability coverage)

◥ The development of a common post-baccalaureate primary care nurse practitioner education program at 10 Ontario universities

evaluation of the NPlCs

◥ The Sudbury pilot NPlC clinic developed and implemented its initial patient satisfaction survey after six months of operation, prior to the official ministry evaluation.

◥ In 2009, there was a ministry-led evaluation of the Sudbury clinic. The goal of the survey was to identify lessons learned in order to inform the establishment of additional 25 NPlCs.

◥ The evaluation included document review, key informant interviews (19), focus groups with 20 participants, and a survey of patients (603).

◥ The Sudbury NPlC has expanded to provide services in a remote community and has established a permanent clinic at a second site, for a total of three sites.

evaluation results

◥ The 2009 evaluation showed a high level of awareness of the clinic amongst the public. However, media attention to the NPlC had generated both positive and negative publicity, related largely to interprofessional tensions in the community at the time.

◥ Over 37 % of patients said that their nurse practitioner identified something about their health that they were previously unaware of.

◥ After only one appointment, patients developed a clear understanding of the nurse practitioner’s role and how it differed from the physician role.

◥ Targets for new patients could not be met within the expected timeframe because patients who were registered were highly complex, and many had not received medical attention.

◥ Concerns were raised about the inadequacy of the physician compensation model. Complex patients require more time, and the fee-for-service model was more conducive to seeing patients who required less time – patients who could also be seen by nurse practitioners.

◥ The NPlC model, compared to other models, does not provide funding for physicians to be on call or to receive educational stipends.

◥ The model of the NPlC was seen as appropriate. ◥ Nurse practitioners were working to full scope. ◥ Patients experienced improved access. No patients were turned away due to their medical

complexity, due largely to the physician’s role, which was to see these patients or provide consultation for them when their care fell outside the nurse practitioners’ scope of practice.

◥ There were high levels of patient satisfaction reported. Patients liked the attitude of nurse practitioners, the thoroughness of care, the emphasis on patient education, and the decreased wait times.


looking ahead

◥ There needs to be greater awareness of the nurse practitioner’s role in the broader public as well as amongst healthcare providers, to avoid misunderstandings and to promote the benefits of the clinics.

◥ Greater interprofessional team development would allow for increased collaboration and further improvements in care.

references:

1. diCenso, A., & wyman, R. (2008). Report on visit to Sudbury district Nurse Practitioner-led clinic. mOHlTC.

2. diCenso, A., Bourgeault, I., Abelson, J., martin-misener, R., Kaasalainen, S., Carter, N., et al., (2010). utilization of nurse practitioners to increase patient access to primary healthcare in Canada – thinking outside the box. Nursing Leadership, 23(special issue), 239-259.

3. Heale, R., & Butcher, m. (2010). Canada’s first nurse practitioner-led clinic: a case study in healthcare innovation. Nursing Leadership, 23(3), 21-29.

4. Ontario ministry of Health and long Term Care (2008). Introduction to NP-led Clinics – Application document #1. Available at: www.health.gov.on.ca/transformation/fht/fht_mn.html.

5. PRA Inc. Research & Consulting (2009). Evaluation of the Sudbury district Nurse Practitioner Clinics. Final Report. mOHlTC.


aPPenDIX f: case sTUDY – PaTIenT naVIGaTIon MoDel of caRePatient Navigation Model of Care, Initiative of Cancer Care Ontario (CCO)

headline: Is it cancer? Nurse-led patient navigation reduces wait times and improves patient experience from the time there is suspicion of cancer to diagnosis

The Challenge: Why establish the Patient Navigation model?

The Patient Navigation model for cancer care was implemented across Ontario based on a number of identified factors and needs.

◥ Patients were experiencing long wait times for diagnostic tests. ◥ There was a complicated process for diagnostic assessment. ◥ Patients reported high levels of anxiety and stress due to uncertainty. ◥ Patients were experiencing difficulty accessing information. ◥ limited supports were available for patients. ◥ There was a need to spread innovative practices in the field. (For example, the pilot project

included registered nurses performing flexible sigmoidoscopy and nurses using patient navigation strategies, both of which were highly appreciated by patients.)

Potential benefits of the Patient Navigation model

It is anticipated that Patient Navigation model, when successfully implemented, will:

◥ Reduce wait times for diagnostic tests. ◥ Improve patient experience and satisfaction. ◥ decrease patient anxiety and stress. ◥ Allow for early assessment of clinical status and interventions related to symptom management. ◥ Improve provider satisfaction. ◥ Address gaps in the healthcare system and/or mitigate or circumvent the gaps. ◥ Improve coordination between different parts of the system.

About the Patient Navigation model: history, purpose and scope

Patient navigators work collaboratively with surgeons, specialists and other health professionals, and support staff, managers and steering/advisory committees. They work closely with the referring physician or nurse practitioner, supporting the patients by addressing their questions; referring and coordinating diagnostic tests; triaging symptoms and clinical status; making referrals for symptom distress; addressing social supports; and managing patients’ anxiety and stress. under the model, patient navigators can be registered nurses or registered practical nurses, social workers, or lay persons.


Cancer Care Ontario (CCO) piloted the role of patient navigator in January 2010 for two programs – thoracic/lung and colorectal cancer – to be part of the 14 newly established diagnostic Assessment Programs (dAPs). dAPS were established at the same time to provide patient-centred care, information and linkage to the care team. A dAP is a place where patients going through the process of diagnosing for cancer can manage and coordinate the care and treatment they need in one single and central location, have access multi-disciplinary healthcare teams that can provide medical services for diagnostic cancer, and receive support services in a patient-focused environment.

A two-phase pilot program was funded by the Nursing Secretariat within the Ontario ministry of Health and long-Term Care. Each phase involved implementing seven patient navigator positions.

The role of nurses as patient navigators

◥ Collaborates with the interprofessional team members and coordinates patient care from referral to definitive diagnosis.

◥ Assesses patients’ symptoms and clinical status that may lead to referrals for interventions; and provide patients with information and support.

◥ Addresses barriers to diagnostic tests and healthcare services. ◥ Identifies health system gaps and advocates to have these addressed.

development and implementation of the Patient Navigation model

◥ Exploratory work was done over a one-year time frame. This work included doing a literature review and conducting focus groups with existing patient navigators and other key informants.

◥ Steering committees and/or advisory committees composed of key stakeholders were established at each dAP to provide direction and oversight.

◥ A total of 14 navigators were identified and situated in dAPs. Programs were established to provide comprehensive diagnostic assessment to patients with suspicion of cancer.

◥ Phase 1 of the pilot was launched in January 2010 for seven patient navigators at seven dAPs. Phase 2 was launched in April 2011 for another seven patient navigators. lessons learned from phase 1 informed the implementation of phase 2.

◥ dAPs were spread across the province, which provided the opportunity to adapt the patient navigator role to different contexts.

◥ The navigators could be registered nurses or registered practical nurses. Several sites decided to utilize advanced practice nurses.

◥ Funding covered salary and benefits of the patient navigator, costs related to training, provincial meetings, and program evaluation. The dAPs contributed additional funding for clerical staff, office and other overhead costs.

◥ Patient navigators across the province participated in a national patient navigation working group of the Canadian Partnership Against Cancer (CPAC). This working group provided additional supports, knowledge exchange and networking across Canada.

◥ The de Souza Institute developed a course on patient navigation across the continuum of care. All 14 patient navigators took the course, which included online learning modules and a full-day clinical session using simulated patients. It is interesting to note that many other nurses also enrolled in the education program, applying the learning to other clinical roles.


◥ The navigators worked with physicians and many other staff within the dAPs to develop medical directives, clinical pathways and other protocols to facilitate patient care.

◥ A number of planned meetings were held to bring the patient navigators together for cross-sharing, learning and problem-solving. These meetings helped provide additional supports to the dAPs and to the patient navigators.

evaluation of the Patient Navigation model

◥ Cancer Care Ontario established and implemented an evaluation plan, funded by CPAC. ◥ The program evaluation framework included evaluation of impact of patient navigation on system

efficiency (diagnostic wait times), patients’ experience, and provider feedback. ◥ data sources included the following:

◥ data on wait times, tracked by dAPs ◥ Assessment of patient physical and emotional symptoms using the Edmonton Symptom

Assessment System (ESAS) ◥ Problems identified through the Canadian Problem Checklist tool (used in phase 1 only) ◥ Patient experience surveys ◥ Interviews conducted with patient navigators, managers, physicians and support staff

evaluation results

◥ The patient navigator role was unique to each dAP as expected. Some differences were a result of the type of dAP and/or the way the dAP was designed, and involved different elements of virtual and in-person interactions with the patients. more mature dAPs had navigators who took on a lot more responsibility for tests and decision-making within the parameters of standing orders and/or medical directives.

◥ The level of education, confidence, interprofessional collaboration, and physicians’ knowledge of the nurses’ scope of practice, as well as mutual trust between providers, were factors that influenced the types of responsibilities held by the patient navigators. Some dAPs were underdeveloped to the extent that the navigators were not able to realize their clinical role.

◥ High levels of patient satisfaction were reported (91% satisfied or very satisfied). Areas of satisfaction included the availability of the navigator to the patients; information on tests and test results; and management of symptoms, anxieties, worries or concerns.

◥ Reductions in wait times were reported: after 18 months, pilot sites had a 50% reduction in their average time to diagnosis.

◥ There were reductions of more than 30% in symptom severity including anxiety, pain, well-being and tiredness.

◥ 30% of thoracic patients experienced improvement in breathlessness as a result of navigator support, which included use of the dyspnea Guide-to-Practice.

◥ There was improved information provision and support to assist patient decision-making. ◥ High satisfaction was reported among providers (navigator, physicians, managers, and support staff). ◥ There was evidence of improved referral systems (centralized), improved care paths, support

systems for patients, and decreased situations where patients were “falling through the cracks.” ◥ The program was a catalyst for system improvements through advocacy and facilitation by the navigator.


looking ahead

◥ Based on promising results of the pilot project, a formal patient navigator program has been established across Ontario.

◥ The program will expand as dAPs expands, pending funding allocation. ◥ The current 14 patient navigators have base funding allocation from the ministry of Health and

long-Term Care. ◥ A community of practice for patient navigators has been established to continue to provide a

forum for ongoing work.

reference(s)

1. Cancer Care Ontario (march 2011). Patient Navigator Pilot – Progress Report 2010-2011. unpublished.2. Cancer Care Ontario (February 2012). Patient Navigation in Cancer diagnostics Pilot Project.

Final Report. unpublished.3. Gilbert, J., Green, E., lankshear, S., Hughes, E., Burkoski, v., & Sawka, C. (2011). European Journal

of Cancer Care, 20, 228-236.


aPPenDIX G: case sTUDY – sHaReD caRe MoDelShared Care Model – Family Practice Nurses and Family Practice Physicians (The Family Practice Initiative)

headline: Nova Scotia improves access and quality of primary care to its citizens by supporting registered nurses to share primary care practice responsibilities with family physicians and/or nurse practitioners in family practices across the province

The Challenge: Why establish the Family Practice Initiative?

The Family Practice Initiative – an example of the shared care model – has been implemented across Nova Scotia based on a number of healthcare needs and factors.

◥ There is an identified need to increase primary care access for patients. ◥ A high demand exists for services for chronic disease management. ◥ Primary care physicians are working in isolation, particularly those in solo practices or rural areas. ◥ Physicians and patients are encountering difficulties in coordinating care and challenges in

navigating through the healthcare system. ◥ Registered nurses in primary care are not working to their full scope of practice.

Potential benefits of the Family Practice Initiative

It is anticipated that this initiative, once successfully implemented, will:

◥ Increase access to primary care. ◥ Improve quality of care (for example, outcomes related to chronic disease management, screening

and prevention). ◥ Increase satisfaction of providers, with less stress on physicians. ◥ Optimize nurses’ scope of practice by better defining and supporting the role of the family practice nurse. ◥ Provide collaborative support for complex patients who require more time. ◥ make peer support more available through collaborative practice, and in doing so, help to address

issues related to healthcare professionals working in isolation. ◥ Provide an economically feasible model of primary care.

About the Family Practice Initiative (shared care): history, purpose and scope

◥ A pilot project was initiated by Capital Health in 2008-2009, supported by the Nova Scotia department of Health.

◥ The business case was strong: the initiative was cost-neutral for the family practice, and it was anticipated that revenues generated from increased volume would offset costs for family practice nurses’ salary and other expenses.

◥ A recruitment strategy was initially developed to identify interested family practices. The strategy included marketing materials, presentations and one-on-one meetings. Enrolment of physicians and family practice nurses was voluntary.

◥ There was strong support from physician stakeholders.


Key components of the program:

◥ Team manuals are disseminated as part of the program. The manual includes budget requirements, the business case, medical Service Insurance (mSI) guidelines, liability information, and information on nursing roles.

◥ A team resource kit has been developed that includes patient education materials and aides, assessment tools, and reference materials.

◥ An education and orientation program for the nurses is routinely provided by the Registered Nurses Professional development Centre (RNPdC). The program includes an initial five-day orientation program and 10 education modules completed over a one-year period.

◥ Governance and accountability structures and processes have been developed. These include medical directives, a certification program for advanced nursing skills, and billing guidelines.

◥ mentorship and support for the practices (assessment of workflow, collaboration, scheduling, approaches to care) were initially provided by the project lead and are now provided through the RNPdC.

◥ Collaborative team days are organized and held regularly. Nurses and physicians have joint time to strategize on changes needed to improve care.

◥ Financial support is provided to attend collaborative team days and partnership development. ◥ Partnerships have been developed with industry partners, to support collaborative team days and

team resource kits.

roles of nurses in the Family Practice Initiative

◥ under the model, registered nurses are employed in family practice (fee-for-service practice environment). The physicians and nurses build a team approach to patient care.

◥ Focus for care is on disease prevention, screening, complex patients, chronic disease management, follow-up, support, and coordination.

◥ Patient education and infection control practices are developed and coordinated at the practice. ◥ Nurses and physicians are encouraged to have greater involvement in primary care research. The

department of Health provides financial support for the education itself and for education time.

development and implementation of the Family Practice Initiative model

Primary Health Care (PHC) at Capital Health spearheaded a pilot initiative in 2008-2009 with a project lead support. After the pilot project was completed, the department of Health provided standards, supports and financial support to all districts to continue to implement the initiative.

evaluation of the Family Practice Initiative

◥ An evaluation plan was developed using a logic model and an evaluation matrix with defined indicators and key data sources.

◥ An evaluation consultant was hired to support the evaluation. ◥ Phase 1 evaluation was conducted in February 2009. The focus was on process evaluation using

document review, surveys, and the service tracking form. ◥ Phase 2 evaluation was conducted in June 2010. The focus was on the impact of the initiative, and

included client surveys and chart audits as well as data sources from phase 1.


evaluation results

The evaluation of the pilot project revealed that local autonomy and decision-making had resulted in various physician and nurse collaborations.

◥ Of the 10 practices that provided information, the majority of them had hired one Family Practice Nurse (FPN). 6 out of the 10 practices reported that the FPN had her own patient appointments and in the remaining 4, they shared the appointment. 7 out of 10 FPNs had their own examination rooms.

◥ Fewer than half of the collaborations had policies/procedures for risk management, patient safety and medication errors.

◥ 6 out of 10 had job descriptions for nurses. ◥ 2 had medical directives, policies and procedures. ◥ 4 had an employment contract. ◥ The family practices incorporated learners and students in their practices. ◥ There was enhanced participation in primary healthcare research.

Findings from the process evaluation

◥ Provider satisfaction was noted in decision-making processes, clarity/understanding of roles in collaboration, and communication.

◥ different communication mechanisms were used by different practices. These included informal communication, e-mails, to-do lists, regular meetings, and team- building workshops.

◥ 80% of practices improved their clinical protocols or assessments to coordinate patient care, vaccine management, recording of current medications, and infection control.

◥ Improvements were found in documentation – both in information capture and use (patient profiles, quality indicators).

Findings from the outcome evaluation

◥ All physicians would recommend hiring family practice nurses to their colleagues. ◥ They identified improvements in time with patients and rapport; balance between patient care and

paperwork; and improvements in level of care. ◥ 60% of physicians had improved satisfaction on how care was coordinated within the healthcare system. ◥ The Family Health Initiative practices improved comprehensive screening and care for both

episodic and chronic disease management (particularly with cardiovascular patients). ◥ Improved access to primary care was achieved; 50% of practices accepted new patients; there were

decreased wait times for regular appointments and more patients scheduled per hour; and patients reported ease in getting an appointment.

◥ There was an increase in referrals to a variety of community programs. ◥ Patients provided top ratings on nurses’ listening, how seriously nurses took patients’ health concerns,

thoroughness of nurses’ assessments, and the ease at which the nurses put the patients. Over 90% reported overall satisfaction with the nurse and the clinic. All would recommend the nurse to others.


◥ The majority of patients reported positively on health promotion and prevention items, indicating specifically the nurses’ role in providing lifestyle information, advice and influence.

◥ Improvements were found in annual testing for fasting lipid profile, foot assessments (for patients with diabetes), fasting blood sugar tests (patients with CAd), and blood pressure measurements (patients with CAd).

◥ There was an increase in patients with depression who were offered non-pharmacological treatments (nurses do not prescribe medications under this model).

looking ahead

Several recommendations and areas for improvement were identified through the pilot evaluation, to be considered as the Family Health Initiative continues to be implemented.

◥ There needs to be adequate time for physician-nurse collaboration, training and mentorship. ◥ There are continuing pressures on the financial feasibility and sustainability of including family

practice nurses in these practices. Practices can be cost-neutral only if they increase their volumes of patients. many of the practices are not covered by the fee codes, creating constraints for nurses.

◥ It is important to continue to build patient acceptability of the family practice nurse’s role and scope of practice.

◥ There needs to be a focus on preventive strategies and screening for specific areas that require improvement.

◥ Inefficiencies in billing practices should be addressed, so that the patient does not have to see the physician each time.

◥ There is a need for nursing leadership to address ongoing issues and practice development. ◥ Currently, the family practice nurses do not have a benefits package with their salaries.

references

1. magee, T., Hodder-malloy, C., mason, d. (2011). Family practice nursing on the rise in Nova Scotia. doctorsNS, September, 31.

2. Registered Nurses Professional development Centre, Family Practice Program (may 2011). Family Practice Program. Available at: rnpdc.nhealth.ca.

3. Registered Nurses Professional development Centre, Family Practice Program (April 2011). Are you struggling to keep up with the growing burden of chronic disease in your practice? Available at: http://www.gov.ns.ca/health/primaryhealthcare/documents/Family-Practice-Brochure-Physicians.pdf.

4. Research Power Inc. (2009). Capital Health FPN Initiative. Evaluation Report Phase 1. Accessed from Graeme Kohler at Capital Health.

5. Research Power Inc. (2011). Family Practice Nurse Initiative. Summary Report. Accessed from Graeme Kohler at Capital Health.


aPPenDIX H: facToRs InflUencInG aPPlIcaTIon of MoDels of caRe In PRIMaRY caRe

Success Factors and/or Challenges references

PolICy/SyStem leVel FACtorSPolicy decision-makers understanding of roles such as of NP Sangster et al, 2010Pan-Canadian approach to legislative and regulatory framework development and implementation

diCenso et al, 2010

donald et al, 2010

Stevenson & Sawchenko, 2010Graduate level education for advanced nursing practice roles dICenso et al, 2010

donald et al, 2010Good data and research to understand current status and impact of changes in the system, for example to assess impact of NPs already in the system – patient volume, access. Health human resource planning to encourage collaboration and coordination of services (also appropriate numbers, distribution, skills)

donald et al, 2010

macAdam, 2008

minore & Bones, 2002

Tomblin murphy Consulting Inc, 2005Restrictive/barriers posed by legislation and regulation (restrictions on prescribing drugs, break down barriers that encourage silos)

donald et al, 2010

dufour & deborah-lucy, 2010

mcPherson et al, 2012

Oandasan et al, 2006Professional malpractice martin-misener et al, 2004

Oandasan et al, 2006Appropriate compensation models for physicians (has to have incentives if they are not to bill) and other providers (NPs, for example)

de Guzman et al, 2010

dufour & deborah-lucy, 2010

Goldman et al, 2009


Oandasan et al, 2006

Rosser et al, 2011

Schadewaldt et al, 2011Innovative funding mechanisms for teams to operate Baumann et al, 2009


Patterson et al, 2009

Stevenson & Sawchenko, 2010Interprofessional education, pre-licensure and post- licensure Goldman et al, 2009


Oandasan et al, 2006Curriculum for family practice nurse or family health nurse Alsaffar, 2005

Brynes et al, 2012Educate physicians, other team members and public at large on nursing roles

Alsaffar, 2005



New standards for service delivery, evidence-based processes/interventions Goldman et al, 2009

Russel et al, 2009Global set of metrics mcPherson et al, 2012Standardized language across providers – support consistent and standardized measures

Barton et al, 2003

Greater networking on IPE/IPC Côté et al, 2008APProPrIAte model oF CAre

Community needs assessment – model must work for community of patients – what are the high needs such as extent of unattached patients (no physician); models may require changes as the needs of the population changes

dufour & lucy, 2010 Psooy et al, 2004

Ragaz et al, 2010

Patient population characteristics and needs Clement et al, 2006

minore & Bones, 2002Client-centred approaches Baker & denis, 2011

Clement et al, 2006Patient willingness to receive care from alternates, teams Byrnes, 2012

Craven et al, 2006Involvement of patient and family demiris et al, 2008

Pauzé, et al, 2005Involvement of stakeholders early on (for example, unions related to nurse practitioners)


Sangster et al, 2010multi-component model – important components – patient education, systematic follow-up, medication adherence

Craven et al, 2006

Humbert et al, 2009

malin & morrow, 2007length of engagement with patient/Intensity of interventions Schadewaldt & Schulz, 2011

Sicotte et al, 2004Process – holistic approach – assessment, including monitoring and evaluation, screening for complications, health teaching, case management (coordination of care, appropriate referrals), treatment and procedures for managing health issues, symptom management, diagnoses,

Goldman et al, 2009

wong & Chung, 2006

Group visits, shared appointments watts et al, 2009Presence of NPs in teams diCenso et al, 2010

Humbert et al, 2009

Soeren et al (2003)Scope of practice – based on roles Brynes, 2012

Cioffi et al, 2010


martin-misener et al, 2010


Oandasan et al, 2006

Sangster et al, 2010



INdIVIduAl ANd teAm leVel FACtorSEffective teams – clear purpose, objectives, goals, communication, coordination and mechanisms to address conflicts; non-hierarchical/equity

Byrnes, 2012

Clement et al, 2006

Goldman et al, 2010

Hall et al, 2008

Hillier et al, 2011

Howard et al, 2011

Humbert et al, 2009

Huron Pert Health Alliance, 2010

martin-misener, 2004

Sangster et al, 2010mutual trust, power balance Akeroyd et al, 2009

Baxter & markle-Reid, 2009Knowledge and experience working in teams Reeves et al, 2009Knowledge of each other’s roles and scope of practice Byrnes, 2012

Ragaz et al, 2010willingness to collaborate, have a common goal, relinquishing professional “turf”, collaborative relationships

Baxter & markle-Reid, 2009

Byrnes, 2012

Craven et al, 2006

Thornhill et al, 2008Physicians have to share their role Goldman et al, 2010Physician leadership training Baker & denis, 2011Co-location of team members Craven et al, 2006

demiris et al, 2008

Oandasan et al, 2006Enable right tools and information to support teamwork, communication, client-centered approaches including involvement of patient/family in decision-making

Clement et al, 2006

Appropriate scheduling – flexible structures, time for team meetings, collaboration

Byrnes, 2012

orgANIzAtIoN FACtorSCommon grounding philosophy consistent with primary healthcare dufour & deborah-lucy, 2010Clear business plan Ragaz et al, 2010Selecting the most appropriate healthcare providers dufour & lucy, 2010Hire experience, competent nurses, confident wong & Chung, 2008medical directives Humbert 2009Need interprofessional organization interventions (staffing, policy, workspace, culture changes)

Goldman et al, 2009

New models of governance Goldman et al, 2009



Electronic medical/health records plus unimpeded flow of information and communication; common tools

Baker & denis, 2011

Cioffi et al, 2010

Goldman et al, 2009

macAdam et al, 2010

Ragaz et al, 2010meeting space, other tools demiris et al, 2008

Hall et al, 2008

Humbert et al, 2009Sufficient funding for model to sustain required supports Craven et al, 2006

Patterson et al, 2009model ImPlemeNtAtIoN FACtorS

leverage existing toolkits that have been developed to implement models or roles such NP

Côté et al, 2008

Adequate time for system-level collaboration to develop – requiring staff buy-in, leadership support, formal policy changes, performance monitoring

Craven et al, 2006

Service restructuring to allow model to work – including integration of process (referral mechanisms, consultation processes)

Craven et al, 2006

Goldman et al, 2010

lacopino, 2010Support team development, transformation process from group to team practice

Clement et al, 2006

dufour & deborah-lucy, 2010Address inconsistencies in working relationships between nurses and physicians

donald et al, 2010

Protect from staff turnover, particularly during the implementation phase Taylor et al, 2007Training in chronic disease management Barlow et al, 2002

Giddens et al, 2009Satisfactory delegation of responsibilities Cioffi et al, 2010mentorship for nurses new in roles Alsaffar, 2005

Sangster et al, 2010Evidence-based guidelines/protocols Craven et al, 2006


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Interprofessional Collaborative Teams