This study systematically evaluated ways to improve “structured collaboration” between nurse practitioners and family physicians at two intervention and two control sites in rural and remote parts of Ontario. A learning module on collaborative practice was designed, pilot tested, and then introduced at the intervention sites. After completing the module, the participating health care providers (nurse practitioners and family physicians) selected five actions that could be undertaken in the study time frame to strengthen their own collaboration. The project found that changes occurred at the intervention site once an effort had been made to structure the collaboration. Whereas nurse practitioners assumed increased responsibility for curative activities, took on more complex care of patients, and referred fewer situations to family physicians, the physicians did not change their referral patterns — full collaboration, with a high level of two-way referral, was not achieved. Investigators believe that more time and experience is needed for that shift to occur. New, agreed-upon role guidelines were successfully adapted, and, at the comparison site, in-house referrals to physicians increased during the study period.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.