Dataset Information

Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.

ABSTRACT:

Objective

In Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP-led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care.

Design

An instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In-depth interviews with patients and providers (N=24) and 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data.

Results/findings

Two main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health-care providers. Participants discussed how patients and providers learn from one another to facilitate self-management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers.

Discussion

NP-led GMVs are a method of care delivery that harness NPs' professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient-centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team-based and patient-centred health-care objectives and may disrupt inherent power differentials that exist in primary care.

SUBMITTER: Housden L

PROVIDER: S-EPMC5600247 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Publications

Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.

Housden Laura L Browne Annette J AJ Wong Sabrina T ST Dawes Martin M

Health expectations : an international journal of public participation in health care and health policy 20170110 5

<h4>Objective</h4>In Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP-led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care.<h4>Design</h4>An instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In-depth interviews with patients and providers (N=24) and 10 hours of direct observati ...[more]

PMID: 28071841

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Project description:PurposeWomen with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer.MethodsA group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to February 2014, 148 patients (3-6 per group) participated in a 1-hour informational session followed by a 15- to 30-minute individual visit with a physician that included history, physical examination and evaluation. We surveyed 101 women who attended these visits to evaluate a group model for providing gynecologic care and educational support to women with breast cancer.ResultsOf those who responded to the survey question, 100% agreed or somewhat agreed that their expectations for an initial intake visit were met during the group visit; 81% agreed or somewhat agreed that they felt a group visit was preferable to an individual introductory visit. More than 95% agreed or somewhat agreed that the information was understandable and their questions were answered during the visit. Only 5 respondents expressed dissatisfaction with the additional time commitment for this type of visit.ConclusionsThe majority of women surveyed expressed satisfaction with their experience with a group visit format. The women who participated preferred this format compared to an individual intake appointment when establishing gynecology care after breast cancer diagnosis/treatment, regardless of age, menopausal status, cancer stage or hormone receptor status. While further studies are warranted to directly compare and further assess satisfaction and efficacy, gynecologists may consider using a group model to provide comprehensive education and care to this patient population.

Dataset Information

Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.

Objective

Design

Results/findings

Discussion

Publications

Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.

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