title: Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.
abstract: In 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.
  
  
  
  An 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 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data.
  
  
  
  Two 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.
  
  
  
  NP-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.
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Housden
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC, Canada.|CRiHHI: Critical Research in Health and Healthcare Inequities, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Browne
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC, Canada.|Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.|CRiHHI: Critical Research in Health and Healthcare Inequities, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Wong
authors.affiliation: Department of Family Practice, Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
mesh_terms: D000328:Adult; D002170:Canada; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D020377:Self Efficacy; D000073278:Self-Management; D012959:Socioeconomic Factors
keywords: chronic disease; diffusion of innovation; group medical visits; nurse practitioner; power; quality of care