Pre-Post Analysis of the Impact of British Columbia Nurse Practitioner Primary Care Clinics on Patient Health and Care Experience

Abstract

ABSTRACTObjectiveThis study aims to evaluate the impact of a primary care nurse-practitioner-led clinic model piloted in British Columbia (Canada) on patients’ health and care experience.DesignThe study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-Led clinics. The pre-rostering 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.SettingTo 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 core urban to peri rural.ParticipantsRecruitment 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 measuresThe 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.ResultsScores for all dimensions of patients’ primary care experience increased significantly: Accessibility (T0=5.9, T1=7.9, p<0.000), Continuity (T0=5.5, T1=8.8, p<0.000), Comprehensiveness (T0=5.6, T1=8.4, p<0.000), Responsiveness (T0=7.2, T1=9.5, p<0.000), Outcomes of care (T0=5.0, T1=8.3, p<0.000). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.000) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709).ConclusionsOur results suggest that the NP-Led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.Strengths and limitationsThis study evaluates the impact of a primary care nurse-practitioner-led clinic model piloted in British Columbia (Canada) on patients’ health and care experienceThe study rests on a pre-post survey without a control group therefore the differences observed could be caused by external factorsData collection took place between 2020 and 2022, during the Covid-19 pandemic.Only four NP-PCC clinics exist and participation in the survey was voluntary and uncompensated limiting the number of respondents