Academic journal article Australian Health Review

The Role of Practice Nurses in Coordinated Care of People with Chronic and Complex Conditions

Academic journal article Australian Health Review

The Role of Practice Nurses in Coordinated Care of People with Chronic and Complex Conditions

Article excerpt

Abstract

General practice in Australia must cope with growing numbers of individuals with chronic and complex needs. The Australian Government has recognised the need to reform the primary health care sector to address this issue, with recent initiatives, such as coordinated care. The overall goal of coordinated care at a national level is to facilitate integrated care for people with chronic and complex conditions, by enhancing collaborative partnerships among general practitioners, primary health care providers, community service providers and clients. Interestingly, practice nurses (PNs) have not been identified as key stakeholders in the coordinated care service delivery model in Australia. In contrast, an expanded role for PNs has been in place in the United Kingdom and New Zealand for some time. This paper is based on focus group discussions with Australian PNs who have had a range of experiences in coordinated care models. The study identifies an important role for PNs, suggesting trial of a variety of models of coordinated care that include PNs in chronic disease management process.

Aust Health Rev 2007: 31 (2): 231-238

THE MANAGEMENT of chronic and complex conditions is a major issue for health systems in the developed world today. The Australian health care system has responded to this problem by introducing a number of initiatives; one of which has been coordinated health care. The overall goal of coordinated care is to facilitate integrated care for people with chronic and complex conditions, by enhancing collaborative partnerships among general practitioners (GPs) and non-medical primary and community services providers. Coordinated care is also based on the development of disease management approaches and evidence-based protocols for multidisciplinary care that maximise the likelihood of effective care within existing resources and enhance the coordination of care across acute and primary care sectors. Key stakeholders of coordinated care include: GPs, who act as care coordinators; community and domiciliary nurses from both public and private sectors, whose role is service coordination; service providers from public, private and institutional health care settings; and the target populations (elderly people with chronic conditions).

Interestingly, but not surprisingly, practice nurses (PNs), have not been identified as key stakeholders. This paper explores the possible role of PNs in coordinated care consistent with recent Australian Government financial incentives,1-2 and their experience of current coordinated care activities.

Australian practice nurses

In Australia the title of "practice nurse" refers to a nurse employed to work within a general practice setting. The role of PNs in Australian primary health care has not been defined beyond that of assistants to GPs, and only a minority of general practices employ PNs.3-8 Before 2001, only about 40% of general practices in Australia employed a nurse. These nurses focused on immunisation, wound care, sterilisation, assisting with procedures and tests, some practice management roles and receptionist duties.3-8 The nursing aspect of their role was largely hidden, unrecognised, obscured and undervalued in terms of government resource allocation.

The United Kingdom (UK) provides an interesting contrast to this Australian situation. There has been a well documented and growing presence of PNs in primary health care in the UK over the last decade as a result of financial incentives offered to GPs to employ nurses. The numbers of PNs increased dramatically following the introduction of a new contract for GPs in 1990. By 1995, Draper9 reported that PNs were employed in 88% of British general practices, except in inner London where the proportion was about 66%. This increase in numbers of PNs was accompanied by a significant change in their role from that of treatment room nurse to active involvement or health promotion and management of a multidisciplinary team. …

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