Nurses’ work in relation to patient health outcomes: an observational study comparing models of primary care

作者：Nicolette Sheridan, Karen Hoare, Jenny Carryer, Jane Mills, Sarah Hewitt, Tom Love, Timothy Kenealy, Nelson Aguirre-Duarte, Bruce Arroll, Carol Atmore, Peter Crampton, Anthony Dowell, Tana Fishman, Robin Gauld, Matire Harwood, Gary Jackson, Rawiri McKree Jansen, Ngaire Kerse, Debra Lampshire, Lynn McBain, Jayden MacRae, John Øvretveit, Teuila Percival, Roshan Perera, Martín Roland, Debbie Ryan, Jacqueline Schmidt‐Busby, Tim Stokes, Maria Stubbe, Daniel Watt, Chris Peck · 发表于：Research Square · 年份：2022 · DOI：10.21203/rs.3.rs-2310442/v1 · 研究领域：Emergency and Acute Care Studies、Nursing Roles and Practices、Primary Care and Health Outcomes

Abstract Background Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into different models of primary care. We describe nurse work in relation to these models of care; populations with high health need; and patient health outcomes. Methods Cross-sectional study (30 September 2018), data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥65 years), HbA1c testing in adults with diabetes, immunisations (6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. Results Nurse FTE, and combined nurse, nurse practitioner and general practitioner FTE, were substantially higher in Trust/NGO, Māori, and Pacific practices than Traditional, Corporate, or Health Care Home practices. A progressive increase of clinically complex patients was associated with more clinical input and higher scores on all outcome measures. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Compared to general practitioners, nurses undertook more cardiovascular risk assessment in all models of care except PHO/DHB, and mo...