Roles of nurse practitioners and family physicians in community health centres.

OBJECTIVE: To describe the models of practice used by nurse practitioners (NPs) and FPs in community health centres (CHCs), and to examine the roles of NPs and FPs in these models. DESIGN: Cross-sectional study using an organizational survey completed by managers of the CHC sites, as well as administrative data on patient sociodemographic characteristics and encounter activities. SETTING: A total of 21 CHCs (13 main sites and 8 satellite sites) operating in eastern Ontario during the period from December 1, 2006, to November 30, 2008. PARTICIPANTS: A total of 44 849 patients, 53 full-time equivalent FPs, and 41 full-time equivalent NPs. MAIN OUTCOME MEASURES: Family physicians' and NPs' models of practice, the sociodemographic characteristics and medical profiles of patients who were treated in each model of practice, and FPs' and NPs' use of time. RESULTS: Patients were attributed to 1 of 3 models of practice in CHCs based on the proportion of visits to FPs and NPs: FP care (53% of patients), NP care (29%), and shared care (18%). Patients who received care in the NP model of practice were younger and more likely to be female, be homeless, and not have postsecondary education.Patients who received care in the FP model of practice had more complex medical conditions (cardiovascular disease, mental illness, lung disease, and diabetes) and more annual visits. Patients who received care in the shared care model had intermediate profiles. Nurse practitioners performed more off-site care and walk-in visits. Family physicians and NPs spent a similar proportion of time performing various duties such as direct clinical care and administration tasks. CONCLUSION: Although NPs mainly cared for their own patient panels (in the NP care model), they did share some patients with FPs and provide some care to patients under the FP model of practice. Patients who were cared for by FPs and NPs had quite different characteristics.

A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease.

BACKGROUND: The purpose of this study was to compare the ability of 3 portable oxygen concentrators (POCs) to maintain S(pO2) ≥ 90% during exercise in patients with chronic lung disease. METHODS: Twenty-one subjects with chronic lung disease (18 with COPD, 3 with pulmonary fibrosis) and documented room air exertional S(pO2) ≤ 85% performed four 6-min walk tests: a control walk using the subject's current oxygen system and prescribed exertional flow rate, and 1 walk with each of the 3 POCs (Eclipse 3, EverGo, and iGo) at their maximum pulse-dose setting. RESULTS: S(pO2) was significantly higher pre-walk and post-walk with the Eclipse 3, compared to the other POCs (all P < .01). The subjects also walked farther and maintained a mean S(pO2) ≥ 90% with the Eclipse 3 (both P < .01), which delivers the largest oxygen bolus. The subjects indicated that they preferred the EverGo's physical characteristics, but that the Eclipse 3 responded best to their breathing. The iGo was rated less favorably than Eclipse 3 or EverGo. CONCLUSIONS: The Eclipse 3 was best at meeting the subjects' clinical needs. POC users should be appropriately tested during all activities of daily living, to ensure adequate oxygenation. The healthcare provider should provide information and help to direct the subject toward the most clinically appropriate oxygen system, while being mindful of the patient's preferences and lifestyle. (Clinicaltrials.gov NCT01653730).