Similarities and differences in Swiss general practices with and without nurse practitioners

Background : New care models are needed for the increasing elderly, chronically ill, and multimorbid population, especially in primary healthcare. Rural regions are particularly affected where bottlenecks in provision of care and a shortage of health professionals are emerging. To address these challenges, nurse practitioners have been implemented in Swiss general practices to improve primary healthcare of chronically ill people.

Aim : We aimed to explore Swiss primary healthcare delivery for chronically ill people in general practices with and without nurse practitioners and identify similarities and differences in these general practices.

Methods : We conducted multiple case studies. Data were collected using interviews, observations, patient records, and questionnaires. We described the similarities and differences by drawing on Wagner’s Chronic Care Model and applied deductive thematic cross-case analysis. We included five general practices located in rural areas in Switzerland, with nurse practitioners in two general practices. A total of 34 patients and 26 health professionals were included. The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting standards for organizational case studies were used.

Results : Similarities were that chronically ill patients valued to be perceived as a whole person; guidelines for multimorbidity and reimbursement of relevant services such as coordination were limited. Differences in general practices with nurse practitioners were unclear role allocation, criteria for patient referral were missing and interprofessional teams were in an extended process of change. Nurse practitioners provided a bridge between the general practices and local home healthcare organizations, thereby, strengthening interface management and obtaining a more comprehensive nursing perspective.

Conclusion : This study highlights that new models of care can better respond to patients’ needs as additional nursing skills are available. Interprofessional teams undergo substantial changes in the new care model requiring a revision of existing structures.