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This site was originally developed to support the deployment of primary health care nurse practitioners (PCHNPs) in Quebec. However, it provides a synthesis of the most current scientific data and implementation support tools that could be useful for implementing PHCNPs elsewhere in the world. The best practice recommendations presented here have been deliberately formulated as generically as possible so they can be adapted to different primary care contexts.

Historically, integrating the PHCNP role into different healthcare systems around the world has been a complex process. This process is challenging because it calls for reconsideration of professional boundaries and patient management models. But this is also an innovation whose potential benefits for accessibility and quality of care, as well as for system efficiency, have been widely demonstrated. The aim of this site is to support teams on the ground and help them overcome the challenges of implementing the PHCNP role.

The recommendations coming out of this research have been grouped into six key themes based on the literature and on case studies. The site is structured around these themes and a summary information sheet can be downloaded for each of them.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Specifics on the Quebec experience
Quebec’s Ministry of Health and Social Services (MSSS) decided to deploy PHCNPs in a range of very different settings: GMFs, UMFs, CLSCs (for all acronyms, see the Glossary at end of this page).

The MSSS recommends setting up regional implementation committees to ensure: a) that there are sufficient human resources to respond to population needs, and b) that PHCNP integration is approached consistently across the province. These committees are generally organized by the Regional Health and Social Services Agencies. It is also recommended that local implementation committees be set up to oversee the development of the conditions of PHCNP practice specific to each establishment. Given that the CSSS is the PHCNP’s employer, these committees generally report to the CSSS team, which includes the DSI. However, a partnership agreement is drawn up and signed by the physician partner(s) and the PHCNP. DSIs are particularly responsible for managing and supervising PHCNPs and may play a role in supporting the integration process.

In Quebec, after either completing university training as a PHCNP or obtaining recognition of equivalency, nurses must complete an examination for admission to the Quebec Order of Nurses in order to practice as a PHCNP. However, nurses who are PHCNP candidates may practice under certain conditions while doing a practicum or waiting to take the examination.


Glossary (source)
CSSS: Health and social services centres (CSSSs) were born out of the merger of local community services centres (CLSCs), residential and long-term care centres (CHSLDs) and, in most cases, a hospital centre (CH) and bring together all partners, including family physicians, in order to collectively share responsibility for the population of a territory. At the heart of the local network of services, the CSSS is the basis for an integrated provision of services and ensures accessibility, case management, follow up and coordination of services for this population. The model is based on the provision, close to people’s living environment, of a wide range of primary care services, including public health services, and on the establishment of referral and follow up mechanisms to ensure access to secondary and tertiary care (specialized and highly specialized services).

GMF: Family medicine groups (GMFs) are groups of family physicians who work in close collaboration with nurses from the public network (i.e., the CSSS) in a structure designed to provide family medicine care to registered individuals. Registration with a GMF physician is on a voluntary basis and free of charge.

CLSC: Local community health centres (CLSCs) are public organizations providing primary care in the areas of health and support services such as home care, prenatal classes, newborn care, vaccination, and training in school health and hygiene (for school nurses), etc.

UMF: Family medicine units (UFMs) train residents in family medicine in the primary care setting and provide exemplary care and services to a defined and diverse clientele. UFMs are involved in developing research in family medicine (source: http://www.csssvc.qc.ca/telechargement.php?id=326).
DSP: In a health and social services establishment, the Director of Professional Services (DSP) coordinates the professional, clinical, and scientific activities of many different professionals. The DSP ensures they all work together to provide good quality care and services to the population of a given territory. In close collaboration with other key players, the DSP plays a strategic role in the decisions required to ensure optimal service organization (source: http://www.aqesss.qc.ca).


DSI: Every CSSS or hospital management team includes a Director of Nursing (DSI), who is responsible for setting and pursuing the vision for high-quality nursing services for the entire organization and ensuring the conditions are in place to achieve this quality. The DSI’s role is to create an environment that fosters teaching, research, and the development of clinical excellence (source: www.oiiq.org).

 
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A support site with scientific data and helpful tools for PHCNP implementation