Managing medical service delivery gaps in a socially disadvantaged rural community: a Nurse Practitioner led clinic

Abstract

Objective: The aim of this pilot project was to investigate how Nurse Practitioners (NP) manage medical service delivery gaps in a socio-disadvantaged rural Victorian region.

Design: A cross-sectional study utilising data from patient consultations that took place at the Nurse Practitioner Community Clinic (NPCC) over six months in 2013 and patient satisfaction survey.

Setting: The NPCC is a rural clinic servicing a rural population in Victoria.

Subjects: 629 patients.

Main outcome measures: Numbers of patients; presentations; age; gender; postcode; reason for encounter; consultation length; availability of General Practitioner (GP); consultation activities and follow up; NP Medicare Benefits Scheme (MBS) item number rebate; and equivalent GP MBS item number rebates.

Results: Over 50% of patients were female; 60% aged over 45 years. Patients had 2.6 encounters with the NPCC; over 50% lasting between 10 and 20 minutes. Approximately half the revenue of that claimed in equivalent GP encounters. Common reasons for attendance were symptoms and complaints (37.2%) and attendance was viewed as convenient and accessible, despite having a regular GP (47.8%). Fifty-six Patients responded to a satisfaction survey and indicated they were satisfied with the service would use the service again and would recommend it.

Conclusions: The NPCC provided an accessible service that met patients’ needs in a rural community. The study provides evidence that NPs can provide medical management in areas where medical service delivery gaps exist. However, there was a significant discrepancy between funding reimbursements for services provided at the NPCC and those provided by GPs.