Abstract

The study aim was to determine benefits and challenges of a community initiative to introduce the nurse practitioner (NP) role in rural primary care. We used a mixed-methods, participatory action research design. Data collection included surveys, interviews, patient record data and shadow billing data. Patient, physician and healthcare professional (HCP) surveys were followed by interviews of survey participants and key local informants. Descriptive statistics were used to summarize survey and patient record data, and content analysis was used to analyze interview data. Benefits, challenges and recommendations were the result of mixed-methods synthesis. Forty-one patients, one HCP and four physicians returned surveys, with 14 patients, one HCP, two local leaders and the NP participating in interviews. The NP provided primary care to 10% of clinic patients in a flexible service delivery model. A high proportion of patients had chronic health concerns. Patient outcomes were generally positive, and patients expressed satisfaction with care. Being connected to the community was important to role implementation. Benefits included increased access to cost-effective, quality primary care. Challenges were funding, limited role understanding and potential for role isolation. Recommendations highlight the need for local community buy-in and provincial support in sustaining the innovation.