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首页> 外文期刊>BMC Family Practice >Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia – a multiple case study using mixed methods
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Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia – a multiple case study using mixed methods

机译：澳大利亚初级卫生保健中在协作实践模型中工作的护士和从业医生的经验–使用混合方法的多案例研究

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Background In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. Methods A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Results Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners’ and medical practitioners’ adjustment to new routines and facilitating the collaborative work relied on the willingness and personal commitment of individuals. Conclusions Findings of this study suggest that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, strategic support from healthcare reform decision-makers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice models in primary healthcare.
机译：背景技术2010年，澳大利亚医疗保健系统引入了政策变更，该政策允许护士从业人员在与医生合作的基础上获得公共健康保险计划（Medicare）。这些变化促进了护士从业人员在初级卫生保健机构中的执业。这项研究调查了在新政策下共同努力的护士和医学从业者的经验和看法，旨在确定协作实践模式的推动力。方法采用混合方法研究，对五个主要医疗场所进行了多案例研究。六名护士，十三名医生和三名执业经理参加了研究。通过直接观察，文件和半结构化访谈以及包括有效量表的问卷收集数据，这些量表用于衡量协作水平，对协作的满意度以及对协作收益的信念。对访谈，观察和文件中的定性数据进行了主题分析，然后进行了演绎分析，将主题类别与两种理论合作模型进行了比较。使用描述性统计数据汇总调查问卷的回答。结果使用量表测量，护士和医学从业者报告了很高的合作水平，对其合作关系高度满意，并坚信合作对患者有益。从定性数据得出的三个主题显示出更为复杂和细微的变化：1）政府政策要求和当地基础设施等结构在协作实践模型中使财务从业人员和专业人士处于不利地位; 2）参与者通过重叠，互补，传统和新兴角色的并存而体验了个人角色制定的影响和后果，这模糊了人们对法律责任和共享患者护理报销的认识; 3）护士和医生对新程序的调整，并依靠个人的意愿和个人承诺来促进协作工作。结论这项研究的发现表明，从业者的意愿及其个人关系部分克服了系统限制的影响。但是，需要医疗保健改革决策者的战略支持，以加强护士从业人员的职位，并确保初级保健中合作医疗模式的可持续性。

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