Nurse practitioners, canaries in the mine of primary care reform

Damien Contandriopoulos; Astrid Brousselle; Mylaine Breton; Esther Sangster-Gormley; Kelley Kilpatrick; Carl-Ardy Dubois; Isabelle Brault; Mélanie Perroux

doi:10.1016/j.healthpol.2016.03.015

Nurse practitioners, canaries in the mine of primary care reform

Health Policy. 2016 Jun;120(6):682-9. doi: 10.1016/j.healthpol.2016.03.015. Epub 2016 Apr 11.

Authors

Damien Contandriopoulos¹, Astrid Brousselle², Mylaine Breton³, Esther Sangster-Gormley⁴, Kelley Kilpatrick⁵, Carl-Ardy Dubois⁶, Isabelle Brault⁷, Mélanie Perroux⁸

Affiliations

¹ Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada. Electronic address: [email protected].
² Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada. Electronic address: [email protected].
³ Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada. Electronic address: [email protected].
⁴ School of Nursing, University of Victoria, Canada. Electronic address: [email protected].
⁵ Faculté des sciences infirmières, Université de Montréal, Canada; Maisonneuve-Rosemont Hospital Research Centre, Canada. Electronic address: [email protected].
⁶ Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada. Electronic address: [email protected].
⁷ Faculté des sciences infirmières, Université de Montréal, Canada. Electronic address: [email protected].
⁸ Faculté des sciences infirmières, Université de Montréal, Canada. Electronic address: [email protected].

PMID: 27085958
DOI: 10.1016/j.healthpol.2016.03.015

Abstract

A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound environmental challenges are accumulating and are likely to drive significant transformation in the field. In this article we build upon the concept of "disruptive innovations" to analyze data from two separate research projects conducted in Quebec (Canada). Results from both projects suggest that introducing nurse practitioners into primary care teams has the potential to disrupt the status quo. We propose three scenarios for the future of primary care and for nurse practitioners' potential contribution to reforming primary care delivery models. In conclusion, we suggest that, like the canary in the coal mine, nurse practitioners' place in primary care will be an indicator of the extent to which healthcare system reforms have actually occurred.

Keywords: Nurse practitioner; Primary care; Quebec; Reform.

MeSH terms

Decision Making
Health Care Reform / organization & administration*
Humans
Nurse Practitioners*
Nurse's Role
Organizational Innovation
Patient Care Team*
Primary Health Care
Quebec