Nurse-Physician Collaborative Partnership: a rural model for the chronically ill.
BACKGROUND
Accessibility and quality of primary health care services in rural areas are challenging issues, particularly for the elderly and those with chronic or complex medical conditions. The objective of the Nurse-Physician Collaborative Partnership was to implement and evaluate a collaborative partnership between homecare nurses and family physicians in the rural Trochu-Delburne-Elnora area of Alberta.


METHODS
Overall, 37 patients were enrolled in a shared care plan, which included comprehensive biopsychosocial assessment, early intervention, health education and self-management. Patient and provider outcomes were assessed using quantitative and qualitative data collected at baseline, 6 months and 12 months.


RESULTS
Results showed that patients made improvements in activities of daily living and robust cognitive status. In interviews, patients reported improvements in psychological well-being, knowledge of disease processes and confidence to manage health issues. Patients' use of acute health care services decreased, showing a 51% reduction in the number of days in hospital, a 32% reduction in emergency department visits and a 25% reduction in hospital admissions. Total acute service costs, excluding program costs, decreased by 40% from an average of $15,485 to $9,313 per person (p < or = 0.05).


CONCLUSIONS
Based on these results, policy initiatives that incorporate the shared care model developed in this project may be considered. To our knowledge, this type of evaluation has not previously been conducted in a rural Canadian setting.
Mitton
Craig
C
University of British Columbia Okanagan, Kelowna, BC, Canada. craig.mitton@ubc.ca
O'Neil
David
D
Simpson
Liz
L
Hoppins
Yvonne
Y
Harcus
Sue
S
D000369:Aged, 80 and over; D000416:Alberta; D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D016330:Frail Elderly; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D019555:Physician-Nurse Relations; D011446:Prospective Studies; D019035:Rural Health Services / Q000458:organization & administration*