Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions

作者：Housden Laura^*; Browne Annette J; Wong Sabrina T^*; Dawes Martin

来源：Health Expectations, 2017, 20(5): 862-870.

DOI：10.1111/hex.12525

• chronic disease
• diffusion of innovation
• group medical visits
• nurse practitioner
• power
• quality of care

ObjectiveIn Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP-led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care.
DesignAn instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In-depth interviews with patients and providers (N=24) and 10hours of direct observation were completed. Interpretive descriptive methods were used to analyse data.
Results/FindingsTwo main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health-care providers. Participants discussed how patients and providers learn from one another to facilitate self-management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers.
DiscussionNP-led GMVs are a method of care delivery that harness NPs' professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient-centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team-based and patient-centred health-care objectives and may disrupt inherent power differentials that exist in primary care.

• 出版日期2017-10