Nurse–patient encounters in general practice: patterns in general practitioner involvement and use of nurse-specific Medicare items
Catherine M. Joyce A C and Leon Piterman BA Monash University, Department of Epidemiology and Preventive Medicine, Alfred Hospital, Melbourne, Vic. 3004, Australia.
B Monash University, School of Primary Health Care, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
C Corresponding author. Email: catherine.joyce@monash.edu
Australian Journal of Primary Health 16(3) 224-230 https://doi.org/10.1071/PY10009
Published: 6 September 2010
Abstract
A significant gap exists in knowledge about general practice nurses’ (GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse–patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse–patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse–patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs’ clinical work.
Additional keywords: consultations, practice nurse.
Acknowledgements
We thank the Australian Practice Nurses Association for their support, Lingani Mbalike for data entry, Rory Wolfe for statistical advice, and particularly the participating nurses for their time. This study was supported by a Public Health Postdoctoral Research Fellowship (384363) to the first author from the National Health and Medical Research Council of Australia.
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