CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
http://ahha.asn.au/
  Journal of the Australian Healthcare & Hospitals Association
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Structure
Contacts
For Advertisers
Content
Online Early
Current Issue
Just Accepted
All Issues
Research Fronts
Sample Issue
For Authors
General Information
Author Instructions
Submit Article
Scope
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates
Library Recommendation

ANZ Health Policy

Open access content from the Australia and New Zealand Health Policy journal is now available.


blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image
facebook  

red arrow Connect with AHHA
blank image
facebook TwitterIcon

red arrow Connect with CP
blank image
facebook twitter logo LinkedIn

 

Article << Previous     |     Next >>   Contents Vol 38(3)

Practice nurse involvement in general practice clinical care: policy and funding issues need resolution

Hossein Haji Ali Afzali A C, Jonathan Karnon A, Justin Beilby B, Jodi Gray A, Christine Holton A and David Banham A

A Department of Public Health, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia. Email: jonathan.karnon@adelaide.edu.au; jodi.gray@adelaide.edu.au; christine.holton@adelaide.edu.au; david.banham@sahmri.com
B Faculty of Health Sciences, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia. Email: justin.beilby@adelaide.edu.au
C Corresponding author. Email: hossein.hajialiafzali@adelaide.edu.au

Australian Health Review 38(3) 301-305 http://dx.doi.org/10.1071/AH13187
Submitted: 2 October 2013  Accepted: 14 March 2014   Published: 29 May 2014


 
PDF (116 KB) $25
 Export Citation
 Print
  
Abstract

In Australia, primary care-based funding initiatives have been implemented to encourage general practices to employ practice nurses. The aim of this paper is to discuss limitations of the current funding and policy arrangements in enhancing the clinical role of practice nurses in the management of chronic conditions. This paper draws on the results of a real-world economic evaluation, the Primary Care Services Improvement Project (PCSIP). The PCSIP linked routinely collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of increased practice nurse involvement in clinical-based activities for the management of diabetes and obesity. The findings of the PCSIP suggested that the active involvement of practice nurses in collaborative clinical-based activities is cost-effective, as well as addressing general practice workforce issues. Although primary healthcare organisations (e.g. Medicare Locals) can play a key role in supporting enhanced practice nurse roles, improvements to practice nurse funding models could further encourage more efficient use of an important resource.

What is known about the topic? There is evidence that the increased involvement of practice nurses in clinical-based activities in the management of patients with chronic conditions (e.g. diabetes and obesity) is cost-effective. The Australian Government has implemented financial incentives to encourage general practices to recruit nurses and to expand nursing roles within collaborative models of care. There is currently insufficient engagement of practice nurses in clinical care.

What does this paper add? This paper summarises evidence regarding the value of an enhanced practice nurse role in Australian general practice, and discusses refinements to current funding arrangements for practice nurses.

What are the implications for practitioners? Delegating clinical role (e.g. patient education and monitoring clinical progress) to practice nurses in the management of patients with chronic conditions can improve clinical outcomes without adversely affecting general practice business models.



References

[1]  Australian Government Department of Health and Ageing. Primary health care reform in Australia. Canberra: Commonwealth of Australia; 2009.

[2]  Australian Government Department of Health & Ageing. Building a 21st century primary health care system: a draft of Australia’s first national primary health care strategy. Canberra: Commonwealth of Australia; 2009. Available at http://www.yourhealth.gov.au/ [verified 20 May 2013].

[3]  Australian Medicare Local Alliance. 2012 General practice nurse national survey report. 2013. Available at http://amlalliance.com.au/__data/assets/pdf_file/0003/46731/2012-General-Practice-Nurse-National-Survey-Report.pdf [verified 2 Dec 2013].

[4]  APNA. Nursing in primary care: capturing opportunities. 2012. Available at http://www.apna.asn.au [verified 25 May 2013].

[5]  Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equal care to doctors. BMJ 2002; 324: 819–23.
CrossRef | PubMed |

[6]  Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Asssendelft AJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev 2001; 1: CD001481.
| PubMed |

[7]  Schadewaldt V, Schultz T. Nurse-led clinics as an effective service for cardiac patients: results from a systematic review. Int J Evid Based Healthc 2011; 9: 199–214.
| PubMed |

[8]  Carey N, Courtenay M. A review of the activity and effects of nurse-led care in diabetes. J Clin Nurs 2007; 16: 296–304.
CrossRef | PubMed |

[9]  Houweling ST, Kleefstra N, van Hateren KJJ, Groenier KH, Meyboom-de Jong B, Bilo HJG. Can diabetes management be safely transferred to practice nurses in a primary care setting? A randomised controlled trial. J Clin Nurs 2011; 20: 1264–72.
CrossRef | PubMed |

[10]  Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al Advanced practice nurse outcomes 1990–2008: a systematic review. Nurs Econ 2011; 29: 230–50.
| PubMed |

[11]  Trueman P, Haynes SM, Felicity Lyons G, McCombie EL, McQuigg MSA, Mongia S, et al Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract 2010; 64: 775–83.
CrossRef | CAS | PubMed |

[12]  Sargent GM, Forrest LE, Parker RM. Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: systematic review. Obes Rev 2012; 13: 1148–71.
CrossRef | CAS | PubMed |

[13]  Arts EA, Landewe-Cleuren S, Schaper NC. The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. J Adv Nurs 2012; 68: 1224–34.
CrossRef |

[14]  Halcomb EJ, Patterson E, Davidson PM. Evolution of practice nursing in Australia. J Adv Nurs 2006; 55: 376–88.
CrossRef | PubMed |

[15]  Keleher H, Joyce CM, Parker R, Piterman L. Practice nurses in Australia: current issues and future directions. Med J Aust 2007; 187: 108–10.
| PubMed |

[16]  Haji Ali Afzali H, Karnon J, Gray J, Beilby J. A model-based evaluation of collaborative care in management of patients with type 2 diabetes in Australia: an initial report. Aust Health Rev 2012; 36: 258–63.
CrossRef |

[17]  Haji Ali Afzali H, Gray J, Beilby J, Holton C, Banham D, Karnon J. A risk adjusted economic evaluation of alternative models of involvement of practice nurses in management of type 2 diabetes. Diabet Med 2013; 30: 855–63.
CrossRef | CAS | PubMed |

[18]  Karnon J, Haji Ali Afzali H, Gray J, Holton C, Banham D, Beilby J. A risk adjusted cost-effectiveness analysis of alternative models of nurse involvement in obesity management in primary care. Obesity (Silver Spring) 2013; 21: 472–9.
CrossRef | CAS | PubMed |

[19]  Haji Ali Afzali H, Gray J, Beilby J, Holton C, Karnon J. A model-based economic evaluation of improved primary care management of patients with type 2 diabetes in Australia. Appl Health Econ Health Policy 2013; 11: 661–70.
CrossRef | PubMed |

[20]  Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R, Dwan K, Kljakovic M. Following the funding trail: financing, nurses and teamwork in Australian general practice. BMC Health Serv Res 2011; 11: 38.
CrossRef | PubMed |

[21]  Parliament of Australia. Practice nursing in Australia. Canberra: Commonwealth of Australia, 2007. Available at http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/RP0708/08rp10#_edn37 [verified 5 December 2013].

[22]  Phillips C, Pearce C, Hall S, Kljakovic M, Sibbald B, Dwan K, Porritt J, Yates R. Enhancing care, improving quality: the six roles of the general practice nurse. Med J Aust 2009; 191: 92–7.
| PubMed |

[23]  Britt H, Miller GC, Henderson J, Charles J, Valenti L, Harrison C, et al. General practice activity in Australia 2011–12. Sydney: Sydney University Press; 2012.

[24]  Gordon R. An economic evaluation of the Counterweight Programme in the United Kingdom. Circulation 2007; 116: II-822.

[25]  Department of Health. Medicare Locals operational guidelines. 2013. Available at http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/ml-operational-guidelines-toc~about-ml#.U0txRRAasuM [verified 13 April 2014].

[26]  Halcomb EJ, Davidson PM, Griffiths R, Daly J. Cardiovascular disease management: time to advance the practice nurse role? Aust Health Rev 2008; 32: 44–55.
CrossRef | PubMed |

[27]  Halcomb EJ, Davidson PM, Salamonson Y, Ollerton R, Griffiths R. Nurses in Australian general practice: implications for chronic disease management. J Clin Nurs 2008; 17: 6–15.
CrossRef | PubMed |

[28]  Pascoe T, Hutchinson R, Foley E, Watts I, Whitecross L, Snowdon T. The educational needs of nurses working in Australian general practices. Aust J Adv Nurs 2007; 24: 33–7.
| PubMed |

[29]  Watts I, Foley E, Hutchison R, Pascoe T, Whitecross L, Snowdon T. General practice nursing in Australia. Canberra: Royal Australian College of General Practitioners and Royal College of Nursing, Australia; 2004. Available at http://www.thesandsingpframework.com/documents/gpna_mainreport_watts%202004.pdf [verified 29 January 2014].

[30]  Harris M, Zwar NA. Care of patients with chronic disease: the challenge for general practice. Med J Aust 2007; 187: 104–7.
| PubMed |

[31]  Joyce CM, Piterman L. The work of nurses in Australian general practice: a national survey. Int J Nurs Stud 2011; 48: 70–80.
CrossRef | PubMed |

[32]  Campbell SM, McDonald R, Lester H. The experience of pay for performance in English family practice: a qualitative study. Ann Fam Med 2008; 6: 228–34.
CrossRef | PubMed |

[33]  Maisey S, Steel N, Marsh R, Gillam S, Fleetcroft R, Howe A. Effects of payment for performance in primary care: qualitative interview study. J Health Serv Res Policy 2008; 13: 133–9.
CrossRef | PubMed |

[34]  McDonald J, Harris MF, Cumming J, Powell Davies G, Burns P. The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implications. Med J Aust 2008; 188: S69–72.
| PubMed |

[35]  McGregor W, Jabareen H, O’Donnell CA, Mercer SW, Watt GCM. Impact of the 2004 GMS contract on practice nurses: a qualitative study. Br J Gen Pract 2008; 58: 711–19.
CrossRef | PubMed |


   
Subscriber Login
Username:
Password:  

 


    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2016