title: Nurse practitioners, canaries in the mine of primary care reform.
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.
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada. Electronic address: damien.contandriopoulos@umontreal.ca.
authors.forename: Damien
authors.initials: D
authors.lastname: Contandriopoulos
authors.affiliation: Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada. Electronic address: Astrid.Brousselle@USherbrooke.ca.
authors.forename: Astrid
authors.initials: A
authors.lastname: Brousselle
authors.affiliation: Département des sciences de la santé communautaire, Université de Sherbrooke, Canada; Centre de recherche de l'hôpital Charles-LeMoyne, Canada. Electronic address: Mylaine.Breton@usherbrooke.ca.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.affiliation: School of Nursing, University of Victoria, Canada. Electronic address: egorm@uvic.ca.
authors.forename: Esther
authors.initials: E
authors.lastname: Sangster-Gormley
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Canada; Maisonneuve-Rosemont Hospital Research Centre, Canada. Electronic address: kelley.kilpatrick@umontreal.ca.
authors.forename: Kelley
authors.initials: K
authors.lastname: Kilpatrick
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Canada; Institut de recherche en santé publique de l'Université de Montréal, Canada. Electronic address: carl.ardy.dubois@umontreal.ca.
authors.forename: Carl-Ardy
authors.initials: CA
authors.lastname: Dubois
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Canada. Electronic address: isabelle.brault@umontreal.ca.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brault
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Canada. Electronic address: melanie.perroux@umontreal.ca.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Perroux
mesh_terms: D003657:Decision Making; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners; D024802:Nurse's Role; D009936:Organizational Innovation; D010348:Patient Care Team; D011320:Primary Health Care; D011792:Quebec
keywords: Nurse practitioner; Primary care; Quebec; Reform