Understanding Nursing and Organizational Contributions to Chronic Disease Management within Primary Care
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Background: Innovative strategies have been implemented within primary care across Canada to improve the quality of care that is delivered. One such strategy has been the utilization of interprofessional teams, of which nurses are an integral component. The overall purpose of this thesis was to understand nursing contributions within primary care, specifically related to chronic disease management. Objectives: (1) To determine the roles of nurses in chronic disease management and the extent to which chronic disease management strategies have been implemented within primary care in Ontario, (2) to identify data collection tools that describe/measure primary care organizational attributes, (3) to determine the distribution and nature of organizational attributes across primary care practices in eastern Ontario, and (4) to explore relationships between the presence of nurses within Family Health Teams in south eastern Ontario and Type 2 diabetes health outcomes. Methods: Four studies were performed to address the stated objectives. A provincial nursing survey was conducted to obtain information about the roles of nurses working in primary care in Ontario and the extent to which chronic disease management strategies have been implemented in practices in which nurses work. A systematic search and review was completed to identify data collection tools that collect a broader range of organizational attribute data within primary care. Using the ‘Measuring Organizational Attributes of Primary Health Care Survey’ organizational-level data from practices in eastern Ontario were collected and then linked to diabetic patient outcomes. Results: The nursing survey and organizational attribute survey identified that nurses engaged in a broad range of chronic disease management activities and that chronic disease management strategy implementation was not uniform across practices. Registered nurses were identified as the most prominent non-physician healthcare provider within practices, and the inclusion of registered nurses in practices was associated with improved diabetes outcomes. Conclusions: Nurses are an integral component of primary care and undertake many important activities to support chronic disease management. However, there is an ongoing need to clarify roles between different nursing regulatory designations. This thesis showed positive associations between having at least one registered nurse in a practice and diabetes management indicators.