A mixed methods study examining the influence of general practice and nurse consultation characteristics on patient satisfaction and enablement

The problem

Similar to the rest of the world, in response to demographic changes, increasing chronic disease and demand for primary health care services Australia has increased the role of general practice nurses. Evidence regarding the benefits that nurses can have for general practitioners (GPs), patients and general practice systems is reassuring; however, with the patient at the centre of health care delivery, it is essential to establish whether this care is resulting in improved outcomes for patients. Two key quality outcomes, patient satisfaction and enablement, have been examined extensively as outcomes of GP care; however an evidence gap exists regarding these outcomes in relation to general practice nursing care.

The approach

A convergent, parallel mixed methods study examined the association between general practice and nurse consultation characteristics and patient satisfaction and enablement. The quantitative component consisted of a cross-sectional study involving 21 general practices in an Australian city. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care in these practices between September 2013 and March 2014. Multiple regression and multilevel mixed effect models were used to analyse these data. The qualitative component took a grounded theory approach to in-depth interviews with nurses, patients and practice managers from these same general practices, examining factors that optimised implementation of the nursing role. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling. Each component was analysed on its own. Following this, typology development was employed with the qualitative findings, providing additional variables for integrated analyses.

Findings

Data from a total of 678 completed surveys and 48 interviews were analysed. General practices working with an interprofessional model of care, where nurses worked with broad scopes of practice and high levels of autonomy were associated with higher levels of patient satisfaction and enablement. At the nurse consultation level, both higher satisfaction and enablement scores were evident among patients who felt they knew the nurse well or very well and for consultations of more than 15 minute duration. Patients aged 65 years and over, and those reporting very good or excellent self-rated health also had higher satisfaction scores. Higher enablement scores were also evident among patients who had been attending a general practice for up to 2 years compared with those attending for more than 2 years, and those receiving nursing care for clinical conditions or chronic disease management rather than preventive care.

Consequences

General practice policy and workforce planning needs to consider the value of enhanced nursing scope of practice and autonomy, continuity of nurse providers and adequate time for nurse consultations. Integral to patient-centred care, this evidence substantiates the value of interprofessional and team-based approaches in mediating quality health outcomes for patients.

Credits

• Jane Desborough, National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia
• Michelle Banfield, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
• Nasser Bagheri, National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia
• Rosemary Korda, School of Nursing, Midwifery and Nutrition, James Cook University, Cairns, Queensland, Australia
• Jane Mills, Australian National University Medical School, Canberra, ACT, Australia
• Christine Phillips