Prevalence and associations of general practice nurses’ involvement in consultations of general practitioner registrars: a cross-sectional analysis

Prevalence and associations of general practice nurses’ involvement in consultations of general practitioner registrars: a cross-sectional analysis

Australian Health Review, June 2015

26117411

Allison Turnock, Simon Morgan, Kim Henderson, Amanda Tapley, Mieke van Driel, Chris Oldmeadow, Jean Ball, Jenny Presser, Andrew Davey, John Scott, Parker Magin

Objective To establish prevalence and associations of general practice nurses' (GPNs) involvement in general practitioner (GP) registrars' consultations.Methods A cross-sectional analysis from an ongoing cohort study of registrars' clinical consultations in five Australian states. Registrars recorded detailed data from 60 consecutive consultations per 6-month training term. Problems and diagnoses encountered, including chronic disease classification, were coded using the International Classification of Primary Care, second edition duplication system (ICPC-2plus) classification system. The outcome factor in our analysis was GPN involvement in management of individual problems and diagnoses. Independent variables were a range of patient, registrar, practice, consultation and educational factors.Results We analysed 108759 consultations of 856 registrars including 169307 problems or diagnoses. Of the problems/diagnoses, 5.1% (95% confidence interval (CI) 5.0-5.2) involved a GPN. Follow-up with a GPN was organised for 1.5% (95% CI 1.4-1.5) of all problems/diagnoses. Significant associations of GPN involvement included patient age, male sex, Aboriginal or Torres Strait Islander status, non-English-speaking background (NESB) and the patient being new to the practice. Larger practice size, the particular training organisation, and the problem/diagnosis being new and not a chronic disease were other associations.Conclusions Associations with Aboriginal or Torres Strait Islander status and NESB status suggest GPNs are addressing healthcare needs of these under-serviced groups. But GPNs may be underutilised in chronic disease care.What is known about this topic? GPNs are increasingly involved in team-based care in Australian general practice. The potential positive contribution of GPNs to general practice teams is acknowledged, but the role of the GPN is still being refined.What does this paper add? GPNs contribute to the care of a modest proportion of patients seen by GP registrars. Aboriginal or Torres Strait Islander status and NESB of patients are positively associated with being seen by a GPN; chronic disease is negatively associated with being seen by a GPN. There is geographic variability in prevalence of GPN consultations, not explained by other factors.What are the implications for practitioners? Given the match of GPN skills and attributes to the needs of patients with chronic diseases, GPNs currently may be underutilised in chronic disease care in Australian general practice. The marked geographic variation in uptake of GPNs also suggests scope for greater utilisation of GPNs Australia-wide.