Nurse practitioners in Ontario primary healthcare: Referral patterns and collaboration with other healthcare professionals

Abstract

The purpose of this study is to examine referrals of nurse practitioners providing primary healthcare (PHC NPs) to better understand how PHC NPs collaborate with other healthcare professionals and contribute to interprofessional care. The analysis is based on the data from a survey of 378 PHC NPs registered in Ontario, Canada in 2008. Overall, 69% of PHC NPs made referrals to family physicians (FPs) and 67% of PHC NPs received referrals from FPs. Almost 50% of PHC NPs had bidirectional referrals between them and FPs. Eighty-nine percent of PHC NPs made referrals to specialist physicians. Bidirectional referrals between PHC NPs and social workers and mental health workers were common in family health teams and community health centers. Patterns of referrals (bidirectional, unidirectional and no referrals) between PHC NPs and FPs, social workers, mental and allied health workers in various practice settings indicate development of collaborative relationships between PHC NPs and other healthcare professionals and reflect the influence of practice models on delivery of interprofessional care. These findings are discussed in light of the development of NPs' role and integration of PHC NPs in the Ontario healthcare system. Implications for policy changes and future research are also suggested.

Keywords::

• collaboration
• interprofessional care
• nurse practitioner
• primary healthcare
• referral

Notes

¹NPs are registered nurses who have additional education, experience and the legislated authority to carry out an extended role that includes autonomous diagnosis, ordering and interpreting diagnostic tests, prescribing treatments and performing specific procedures within their scope of practice (Canadian Nurse Practitioner Initiative 2005).

²Details on the 2008 Ontario PHC NP survey development, questionnaire content and data collection method were reported in Koren et al. 2010. The article focused on differences in PHC NP demographic, employment and practice characteristics (clientele profile, percentage of time spent on different activities and collaboration with FPs) in a variety of practice settings. Survey results presented in this paper add to the reporting of the survey findings by describing patterns of referrals between PHC NPs and other healthcare professionals.

³Other practice settings included mental health clinics, aboriginal health access centers, nursing stations, university or college health services, long-term care facilities, public health units, health services organizations and military all combined into one group due to the small number of respondents in each category.