Integrating nursing activities into general practices in Switzerland: a mixed-methods study.

Abstract

Aim: The aim of this study is to describe the rollout of nursing activities during the pilot project's first 12 months (2019-2021), especially relating to what was initially planned in the nurses' job description.

Background: To provide more comprehensive services and reinforce primary care, a pilot implementation study assessed the integration of nursing activities into eight general practitioners' (GPs') practices. The study evaluated how new types of activities were integrated and rolled out over the first year.

Methods: A mixed-methods observational study collected quantitative data on nursing activities and duration and qualitative data via five interviews with nurses and patients and one focus group with six GPs. Investigators combined quantitative and qualitative data in discussions about their results.

Results: New nursing activities were rolled out progressively, especially follow-up activities with chronically ill patients, with a median time dedicated/month of 21h58 (range: 9h25 to 64h50) at six months and 48h43 (range: 11h01 to 59h51) at 12 months. One-off clinical activities are more easily integrated: the median time dedicated/month was 40h01 (range: 13h44 to 74h53) at six months and 40h30 (range: 9h38 to 76h51) at 12 months. Three elements were crucial in the implementation of nursing activities. The nurse's previous professional experience influenced the scope of activities developed. GPs' willingness to refer patients to the nurses enabled the latter to carry out follow-up activities with care plan. Lastly, the implementation of nursing activities was also made possible by patients' acceptance of being cared for by nurse instead of a GP.

Conclusion: Implementation of nursing activities increased progressively, although more slowly for activities with chronically ill patients and within care plans, principally due to the overall change faced by GPs and nurses.