Perspectives of Quebec Primary Health Care Nurse Practitioners on Their Role and Challenges in Chronic Disease Management: A Qualitative Study.

BACKGROUND: Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face. PURPOSE: The study aimed to describe PHCNPs' perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors. METHODS: A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec. RESULTS: PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs' practice, and a more flexible legislative framework. CONCLUSIONS: The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.

Challenges faced by Canadian primary health care nurse practitioners in chronic disease management: A qualitative study among key informants.

BACKGROUND AND PURPOSE: The increasing prevalence of chronic diseases is driving health care systems to rethink their operations. Despite numerous studies supporting the advantages of primary health care nurse practitioners (PHCNPs) in chronic disease management, implementing practices that fully use the skills of these practitioners seems impeded in the Canadian province of Québec. This study explores the views of leaders involved in primary health care regarding the contributions PHCNPs can make in chronic disease management and the challenges they face in doing so. METHODS: Through semistructured interviews, an exploratory descriptive qualitative study was conducted with 20 key informants across Québec who hold a variety of professional positions connected to PHCNPs. CONCLUSIONS: Primary health care nurse practitioners were perceived to be able to improve self-management support for chronic diseases. In reality, however, PHCNPs are mainly devoting their time to clientele in acute care, and current regulations governing their practices limit their involvement in chronic disease management. IMPLICATIONS FOR PRACTICE: Integrating PHCNPs offers a unique opportunity for health care settings to redefine the roles of family physicians and registered nurses and to restructure practices toward a chronic disease-oriented system. A clinical manager should be designated to monitor this restructuring process and ensure its success.