Pre-post analysis of the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience

Abstract

Objective: This study aims to evaluate the impact of a primary care nurse practitioner (NP)-led clinic model piloted in British Columbia (Canada) on patients' health and care experience.

Design: The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-led clinics. The prerostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic.

Setting: To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from urban to suburban.

Participants: Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected.

Primary outcome measures: The survey instrument was focused on five core dimensions of patients' primary care experience (accessibility, continuity, comprehensiveness, responsiveness and outcomes of care) as well as on the SF-12 Short-form Health Survey.

Results: Scores for all dimensions of patients' primary care experience increased significantly: accessibility (T0=5.9, T1=7.9, p<0.001), continuity (T0=5.5, T1=8.8, p<0.001), comprehensiveness (T0=5.6, T1=8.4, p<0.001), responsiveness (T0=7.2, T1=9.5, p<0.001), outcomes of care (T0=5.0, T1=8.3, p<0.001). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.001) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709).

Conclusions: Our results suggest that the NP-led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.

Keywords: GENERAL MEDICINE (see Internal Medicine); Health Services Accessibility; Health policy; Primary Health Care.

Figure 1

Recruitment periods, number of participants and completion rates per sites.

Figure 2

Patient experience of care scores (error bars=95% CI).

Figure 3

Patient experience of care scores per clinic (error bars=95% CI).

Figure 4

Differences in SF-12 scores (T1–T0) error bars=95% CI. SF-12, Short-form Health Survey.

Figure 5

T1–T0 differences in SF-12 scores scatterplot. SF-12, Short-form Health Survey.