Feb 10, 2020
By Gina Pittman

Nurse practitioners: Are we the black hole in health care research?

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Take away messages

  • Comprehensive patient databases are lacking in Ontario which limits research options regarding various acute and chronic conditions that could improve patient outcomes and quality of life.
  • Data representing nurse practitioner practice and outcomes is sparse at best which makes it difficult for patients to make informed decisions regarding their selection of health care providers.
  • For patients to be adequately informed regarding their health care options, nurse practitioner research needs to be conducted and results made available to the public in order for patients to make evidence-informed health care decisions.

Background
As a practicing nurse practitioner (NP) and a doctoral student of the philosophy of nursing at a university in Southwestern Ontario, I had to formulate a research question for my dissertation. This proved to be difficult. My initial plan was to compare the care provided for patients with type 2 diabetes mellitus in NP-led clinics and in primary care physician offices.

Without a readily available patient database, I approached several family physicians in my region regarding access to their patient data. I assured them that all data would remain anonymous and that their practices would not be identifiable. I was advised that they would consider my offer and provide me with a timely response.

Ultimately, the answer was they did not feel comfortable allowing me access to their patient data. This led me to question what data was available to researchers.

Significance
With the lack of physician practice availability, I decided to investigate alternative data sources for NPs and physicians. I contacted the Local Health Integration Network (LHIN) in my region as well as a representative from the Institute of Clinical Evaluative Sciences (ICES), which collects Ontario health-related data.

Surprisingly, I was advised that the LHIN gathers only physician data pertinent to specific clinical indicators, such as diabetes wellness, and ICES does not formally collect data on NP practice. The available data is limited to a small number of NPs who bill provincially for various items through the Ontario Health Insurance Plan (OHIP) and some data collected from settings in which there is an NP–physician mix. Currently, there is no documented data regarding NPs employed in hospital settings.

The provincial government spends millions of dollars to educate and prepare NPs for practice, to create NP positions in hospitals, family health teams, and community health centres, and to establish NP-led clinics. Yet, how is the care provided by NPs and their patient outcomes evaluated?

If data related to NP care and patient outcomes is not collected, evaluating NP education, readiness for practice, and the effectiveness and timeliness of care becomes impossible. Collection of such data would provide a foundation for the current and future evaluation of NP effectiveness in various practice settings.

The scope of NP practice has recently expanded to include the independent ability to prescribe controlled substances. In a time of opioid crisis, information regarding all prescribers is more than relevant—it is crucial. Transparency of NP care and practice is essential to evaluate our clinical competence and to promote a culture of patient safety. Data pertaining to physician care and patient outcomes is collected through OHIP, and I feel it is equally vital for the public to have access to information on NP practice.

… [D]ata would provide the nursing profession and the public with the ability to evaluate NP practice and allow patients to make educated decisions regarding their health care options.

Call to Action
It is time that the Ministry of Health and Long-Term Care implement a process for capturing the NP data that is currently non-existent. Collection and dissemination of data related to NP practice and care are necessary. This data would provide the nursing profession and the public with the ability to evaluate NP practice and allow patients to make educated decisions regarding their health care options.

NPs contribute to the care of persons across the lifespan in various settings. Given our aging population and the increasing demand for primary health care providers, both physicians and NPs, there is a need for data collection regarding NP practice.

As an NP and a researcher, I believe the opportunity to evaluate the care given to patients by NPs would yield invaluable information regarding NP practice. This data would provide evidence to inform policies related to NP education and practice standards, and promote patient safety.

In an era of evidence-informed decision-making in health care, how can we be informed without the evidence?

Gina Pittman, NP, MN, PhD(c) is a graduate student at the University of Windsor, originally from Newfoundland. Her dissertation work is aimed at illuminating nurse practitioner practice.

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