Nurse-patient encounters in general practice: patterns in general practitioner involvement and use of nurse-specific...

A significant gap exists in knowledge about general practice nurses' (GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse-patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse-patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse-patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs' clinical work.