Norma Ponzoni
McGill University, Canada
Title: A Scoping review of the contextual influences shaping the success of primary care nurse practitioner-led clinics across Canada: What lessons can be gleaned for Quebec?
Biography
Biography: Norma Ponzoni
Abstract
Nurse Practitioner (NP)-led clinics, where NPs retain administrative control, have the potential to address current issues of access to primary care services. In Canada, the government of Ontario successfully established 26 publicly-funded clinics over a 5-year period; while in the neighboring province of Quebec, where similar problems exist, the government has only recently funded one NP-led clinic in 2016 after significant political pressure. Inspired by Ontario’s story, this study aimed to understand the initial context and the factors that eventually made conditions favorable; something that can guide Quebec in its struggles to get NP-led clinics off the ground. Using a scoping approach, we retained 8 papers, of which only one was a published ethnography. We used the Edward’s Whole System Change Model to explain the profound effect and interrelatedness of all contributing factors. Core to explaining this dynamic within the healthcare system is the pervasiveness of the biomedical model and a lack of understanding of the NP’s scope of practice; this influences the conditions by which publically-funded care is remunerated and the level of inter-professional collaboration. NPs ‘rallying’ around the cause and engaging in political lobbying and networking is what seemed to make the difference historically in Ontario, and more recently in Quebec. In conclusion, NP-led clinics are a viable and effective option for a large number of Canadian patients who do not have access to primary care providers.