Primary Health Care Service in Canada - Case Study Example

Running head: PRIMARY HEALTH CARE SERVICE IN CANADA Primary health care service in Canada Insert Name Institution Date: Primary health care service in Canada Introduction When Canadians need health care, many of them seek for primary health care service. Examples of primary health care services include family physicians, nurse practitioners, telephone calls to health information lines and pharmacists’ advice. Primary health care is vital to the maintenance and enhancing Canadians’ health and also maintaining quality and sustainability of the health care system. The administration and provision of health care services is the duty of each of the ten provinces in Canada. The country just like many others in the world is carrying out major reforms in its primary health care sector. A major step towards the improvement of primary health care is enhancing the access of the services, particularly in inaccessible communities and areas with shortages of medical personnel. Due to this initiative there has been increased concentration on the integration of primary health care nurse practitioners (Drummond & Bingley, 2003). Nurse Practitioners Nurse practitioners provide important primary health care services to Canadians. These are registered nurses who are specialized in primary health care and offer accessible, complete and effective health care to people or citizens of all ages. They are experienced nurses with additional nursing training which enables them to provide people, families, groups and the community in general with health care services in health enhancement, disease and injury management, cure, rehabilitation and support. A nurse practitioner is an experienced advanced nurse, operating within the complete scope of nursing practice and is therefore neither a second level physician nor an assistant to a doctor. Initially nurse practitioners referred to RNs operating in ambulatory or outpatient settings like public health, clinics and physical offices. The role has since advanced and NPs are generally recognized as having attained additional knowledge, expertise and skills in a particular area of specialty, for instance, neonatology, critical care and diabetes. High level nursing practice analyzes nursing and medical knowledge, focusing on commitment to client-centered care. The NPs can execute roles and duties that were previously thought or considered to be in the domain of the physicians (Drummond & Bingley, 2003). Roles of the Nurse Practitioners The duties of the PHC nurse practitioners consist of a community-based span of practice, usually in collaboration with a family physician, in which high level decision-making skills in evaluation, diagnosis and care management are utilized. The PHC NP offers health care services with emphasis on health enhancement, prevention, and rehabilitation and support services and under the general scope of nursing practice. Based on provincial legislation, the PHC NP has the ability to offer independent care above this scope of nursing practice (Drummond & Bingley, 2003). The role of acute care nurse practitioner consists of managing patients in all health settings, including the supervision of acutely and critically ill or patients suffering from chronic health complications. Their duty also includes offering direct patient care management by conducting in-depth physical evaluations, interpreting and analyzing laboratory as well as diagnostic tests. Other duties include making orders for pharmacotherapeutics and conducting invasive operations like insertion of arterial or central venous catheters. Specialty areas of ACNP practice formerly emphasized on hospital-based care, for instance, critical care, pediatrics, subspecialties of inner drugs and surgery, emergency medicine and several others. The specialties areas have now advanced to clinics and other distinctive settings like home care, long-term care, sports and tropical medication. The two classes of nursing practitioners operate under a mutual model of practice that encompasses all the members of the primary health care service. In the nonexistence of provincial legislation and regulations, the NPs operations are controlled by the existing nursing legislation and protocols or medical instructions stipulated by the NP and the employer. This arrangement may be outlined or left out in a collaborative practice agreement. This agreement is a legal document outlining the NPs scope of practice and duties, practice procedures and reporting structure. The agreement is binding to all the parties, that is, the NP, the Collaborating physician, the employer and departmental head. Success of the NPs A comparison between the nurse practitioners and the physicians conducted within a primary care setting using patient mortality, disability and dissatisfaction as measurement criteria demonstrated that NPs could offer primary health care just as the physicians do. The studies done to establish the methodology for related health result-based trials raised the issue of NPs conducting most of the primary care duties and roles of the family physicians of the Canadian citizens. Independent trials proved that NPs could perform their functions alone in 67% of all the patient responsibilities they are given. They were also cost effective in terms of charges under this kind of setting. The single fee-for-service applied by the physicians is not applicable and conducive for universal adoption by all the NPs in the in the primary care service. The comparison has drawn in resource use and validated assessment measures of client satisfaction and health status. A review of the trials conducted based on client and provider satisfaction, safety and efficiency and the procedure applied indicated that the level of the services provided including the quality, consistency and reliability indicated that nurse practitioners have excelled in the provision of health care services (Drummond & Bingley, 2003). The studies show that the NPs’ services resulting to higher client satisfaction and quality care when compared to the services provided by the family physicians. The outcomes or the end results have no differences implying that nurse practitioners have excelled in provision of health care services. The description patterns, consultations as well as referral offered by the NPs are similar to those provided by the physicians suggesting that the NPs have really advanced in the provision of health care services. In terms of health enhancement treatment recommendations and awareness of their health conditions and treatment plan, the NPs’ patients showed superiority when compared to the physicians’ patients. This can be attributed to the time the NPs spend with their clients whenever they pay them a visit. Though both the physicians and the NPs visit their clients regularly, the NPs services are superior in the sense that their order for mare lab tests as compared to the physicians (Drummond & Bingley, 2003). The nurse practitioners have also succeeded in offering cost effective services which are relevant to most of the Canadians. Irrespective of the many lab tests and visitations that they make, their charges or general costs are manageable while still maintaining the quality of their services. Although their success does not imply that they can replace the physicians in the general operations, the NPs are rather not limited in the services they can provide when compared to the physicians. Factors contributing to the success of NPs Training and education Nurse practitioners are highly trained and experienced in the execution of their duties and responsibilities. PHC NP program was established in Otario primary by the Council of Ontario University Programs in Nursing (COUPN) to offer training to NPs. Currently there are five programs that have been approved as equivalence of Ontario’s education program to offer training to nurse practitioners. The NP certificate course is offered through a combination of labs and tutorials either at the university or through distance education via the net, CD-ROMs, teleconferencing and computer-mediated conferencing. Some of the courses provided include: pathophysiology, therapeutics in PHC and integrative practicum. Nurse practitioners are thus qualified and have the appropriate skills to offer their services. This enables them succeed in their operations. Funding Another factor that contributes to the success of NPs is availability of resources. The Canadian government realized the need to invest enough funds in the enhancement of primary health care system. This led to the creation of the $800M primary health care transition fund. These funds have supported the provision of health care services and also facilitated reforms in the PHC sector. In particular, PHCT funds supported the transitional expenses involved in the introduction of new methods in delivery of PHC services. NPs are therefore not strained in offering primary health care services. NP regulation PHC NPs are registered professional nurses who have exhibited competence to perform extra controlled functions by acquiring the designation extended class, that is, RN (EC). Their operations are therefore controlled by the college of nurse of Ontario. Their standards of practice which are published by the CNO are: practice expectations, expectations for consultations and standards for prescribing drugs. Others are governing practices and appendices which include list of drugs that they can prescribe and lab tests that they can order. As a result of these regulations, nurse practitioners are excellent in provision of their services. The expectations published by CNO ensure that they offer quality services (Drummond & Bingley, 2003). Drawbacks In spite of the great potential that nurse practitioners hold towards making significant improvements and contributions in the primary health care, their integration into the system has been irregular and inconsistent. As a consequence, there have been discrepancies in legislation, regulatory structures and training of the NPs. This inconsistency should be addressed by focusing on five major areas which include: training preparation, practice, government legislation, and health human resource planning and change management. Chance for improvement The services offered by nurse practitioners can be improved by capitalizing on the frameworks designed by Nurse Practitioner initiatives. The frameworks will facilitate the comprehension of NP practices and NPs involvement in interdisciplinary teams. They will also facilitate the establishment of recommendations for actions towards the enhancement of NPs’ sustained integration in the health care system. The NP can also improve the provision of their services by utilizing the funds provided by the primary health care transition fund. They could for instance, increase the number of visits to patients and also the number of lab tests in an effort to improve the quality of the services offered. Implication of Nurse practitioners Nurse practitioners are significant in the provision of health care services to the communities living in Canada. The NPs have succeeded mainly in provision of preventive and supportive services and have been of great help to their patients. They provide a wide range of services including those provided by the family physicians and are thus flexible in their operations. Their services have been found to be cost effective, efficient and of high quality and are thus a major constituent of the general health care system (Drummond & Bingley, 2003). Conclusion PHC in Canada is vital to maintenance and enhancement of health among the citizens of Canada. Nurse practitioners are particularly relevant in the system because of their flexibility especially in performing roles initially reserved for the family physicians. The collaboration between nurse practitioners and family physicians is significant in meeting the demands of communities living in various places within Canada. In order to improve the PHC system both qualitatively and quantitatively, health care personnel and policy makers should introduce expansive alternative models of service delivery into the system. Since the NPs are capable of offering a wide range of health services, their roles should be expanded while limiting the access of physicians who are considered to be less cost-effective (Drummond & Bingley, 2003). Recommendations In order to improve the quality and efficiency of services provided in the PHC system, nurse practitioners should be highly involved in the provision of rehabilitative care. This role which has been left to the family physicians to a greater extent would be performed more effectively by the nurse practitioners. It is thus recommended that nurse practitioners should get more involved in rehabilitation care as they are in better positions to conduct more lab tests and visit the clients regularly. Although the nurse practitioners are actively involved in provision of preventing and supportive care, a little more involvement in provision rehabilitative care would lead to better outcomes (Drummond & Bingley, 2003). It is also recommended that family physicians and nurse practitioners should collaborate in the delivery of a complete primary health care to meet the demands of a particular practice population. This can only be enhanced through application of knowledge and skills relevant to the health care sector. The two should collaborate in offering services in all the five domains of PHC which include: health enhancement, disease prevention, curative, rehabilitative and supportive care. Nurse practitioners who were found to be underutilized in provision of curative and rehabilitative care should get more involved in the same while the family physician should get active in disease prevention and supportive care. Bibliography College of Family Physicians of Canada. Primary care and family medicine in Canada: a prescription for renewal. Toronto: The College; 2000. Drummond, A.J. & Bingley, M., 2003. Nurse practitioners in the emergency department: A discussion paper. Can J Emergency Med 2003:5(4):276-80 Registered Nurses Association of Ontario. RN effectiveness: clinical, financial, and systems outcomes focus on 1998 literature: primary health care nurse practitioner. Toronto: The Association; 2002 p. 3. Report on the integration of primary health care nurse practitioners into the Province of Ontario. Retrieved on December 17, 2009 from Read More