title: The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study.
abstract: BACKGROUND
  The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models.
  
  
  RESULTS
  Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care.
  
  
  CONCLUSIONS
  This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
authors: Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia. Electronic address: jane.desborough@anu.edu.au.
authors: Jane
authors: J
authors: Desborough
authors: Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
authors: Nasser
authors: N
authors: Bagheri
authors: National Institute for Mental Health Research, Research School of Population Health, Australian National University, Australia.
authors: Michelle
authors: M
authors: Banfield
authors: Nursing, School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
authors: Jane
authors: J
authors: Mills
authors: Social Foundations of Medicine, Australian National University Medical School, Australia.
authors: Christine
authors: C
authors: Phillips
authors: National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
authors: Rosemary
authors: R
authors: Korda
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D017060:Patient Satisfaction; D017009:Professional Autonomy; D011787:Quality of Health Care
keywords: General practice; General practice nursing; Mixed methods; Nursing scope of practice; Patient enablement; Patient satisfaction; Primary health care; Quality of care