Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study

Area of Science:

• Primary Health Care
• Nursing Practice
• Health Services Research

Background:

• Global healthcare access crisis necessitates innovative primary care models.
• Increased reliance on nurse practitioners (NPs) and examination of their patient panel capacity.
• Focus on factors influencing NP patient panel size in Canadian team-based primary care.

Purpose of the Study:

• To investigate factors influencing nurse practitioner patient panel size.
• To understand the dynamics of team-based primary care in Ontario, Canada.

Main Methods:

• Multiple case study design involving eight team-based primary care practices (rural and urban).
• Inclusion of nurse practitioners with at least two years of experience.
• Content analysis of in-person interviews with 40 participants (NPs, administrators, physicians).

Main Results:

• Patient, provider, organizational, and system factors influence NP patient panel size.
• Key sub-factors include patient needs complexity, holistic nursing, NP experience, team dynamics, and administrative support.
• NP holistic approach to care, addressing social determinants and comorbidities, impacts panel size, often termed a 'grey area'.

Conclusions:

• NPs' holistic care, addressing social determinants and comorbidities, reduces panel size due to comprehensive patient needs assessment.
• Multidisciplinary teams can optimize service delivery to better meet patient health and social needs.
• Strategic structuring of team services can potentially increase NP patient panel capacity.