Co-developing a research plan to investigate inter-disciplinary experiences, enablers, challenges and unintended outcomes of nurse practitioner integration into primary care in Island Health

Co-lead: 

  • Darcy Ross
    Island Health

Team members: 

  • William Cunningham
    Island Health
  • Patti Telford
    Nurse & Nurse Practioners of BC
  • Zachary Matieschyn
    BC Ministry of Health
  • Christina Berlanda
    Island Health
  • Shelley Tice
    Island Health
  • Danielle Daigle
    Nurse & Nurse Practioners of BC
  • Angela Wignall
    Island Health
  • Jinelle Woodley
    Island Health
  • Steve Goodchild
    Island Health
  • Brenda Warren 
    Island Health
  • Leanne Rowand
    Main Island Health Centre
  • Lorine Scott
    FNHA

Nurse Practitioners (NPs) have practiced in BC since 2005, and are qualified to provide holistic primary care across the life span, similar to primary care physicians. Until 2018, NPs were health authority employees in salaried positions; in 2018 the MOH announced 200 new community NP positions and a contract payment structure option. Numerous contracted NP positions have since been introduced in Island Health. Integrating contracted NPs into an established primary care model traditionally provided by doctors has exposed unique challenges, opportunities and unintended outcomes. Although all stakeholders have generally worked well together, unanticipated conflicts and inefficient work flow impacts have arisen. Integrating inter-professional scopes of practice into an efficient and seamless system of innovative primary care in context of mixed expectations has been challenging. Published evidence suggests that full NP role optimization is affected by practice environments. We aim to develop a research plan to identify the enablers, challenges and unexpected outcomes, and determine how innovative processes enabling focused collaboration, clear scope of practice and improved teamwork can improve flow and access in primary care.

Digital storytelling: Bringing evidence-based treatment for C. difficile infection closer to home

Co-leads:

  • Christine Lee
    Island Health
  • Katharine McKeen
    Victoria Division of Family Practice

Trainee:

  • Jocelyn Chai 
    University of British Columbia

Dr. Christine Lee and her research co-lead Dr. Katharine McKeen, a primary care physician (PCP) with the Victoria Division of Family Practice (DFP), are employing a patient-oriented research (POR) approach to raise awareness and disseminate evidence of fecal microbiota transplant (FMT) to treat recurrent Clostridium difficile infection (rCDI). FMT, the administration of feces from a healthy screened donor, is demonstrated to be both safe and more effective than the usual ways to treat rCDI. Estimates from three recent Canadian studies indicate that only 1,000 rCDI patients have received FMT, yet approximately 10,000 Canadians each year are diagnosed with rCDI.

The team is proposing a distributed knowledge translation approach, one that will enable them to reach diverse stakeholders: patients, families, PCPs, and healthcare decision makers (HCMs). Using a POR approach, they will co-develop a digital story that will enable their patient partner to share her lived experience of rCDI and FMT, and then the research team will relay the evidence for FMT. This video will be used for public outreach and as an education tool. They will also engage PCPs and HCDMs through presentations at their respective networks. During this outreach, the digital story will be displayed.

The overall goal is to increase FMT access for patients diagnosed with rCDI. The objectives are to:

  1. Raise awareness of rCDI and FMT.
  2. Inform stakeholders of FMT’s safety and effectiveness.
  3. Engage PCPs and HCDMs in a constructive dialogue to discuss the benefits of and evidence for FMT for rCDI.

The expected outcomes and outputs are to:

  1. Raise stakeholder awareness of FMT and its benefits as a treatment for rCDI. Output: Production and launch of a digital story telling video on rCDI and FMT as an education and public awareness tool.
  2. Foster communications with PCPs and increase their awareness of regional FMT resources. Output: Share the digital story and engage PCPs in a constructive dialogue via a café scientifique style discussion at the DFP “Dine and Learn” session.
  3. Increase HCDMs awareness of regional FMT resources and FMTs positive contributions to the healthcare system overall. Output: Share the digital story and engage HCMs through presentations to Island Health's Medical Advisory and Clinical Practice Councils.

The team will evaluate the impact of their work by using the domains of the Canadian Academy of Health Science “Making and Impact” framework: advancing knowledge; research capacity building; informed decision making; health impact; and broad social and economic impact.