Managing medical service delivery gaps in a socially disadvantaged rural community: a Nurse Practitioner led clinic

Objective The aim of this pilot project was to investigate how Nurse Practitioners (NP) manage medical service delivery gaps in a socio‐disadvantaged rural Victorian region. Design A cross‐sectional study utilising data from patient consultations that took place at the Nurse Practitioner Community Clinic (NPCC) over six months in 2013 and patient satisfaction survey. Setting The NPCC is a rural clinic servicing a rural population in Victoria. Subjects 629 patients. Main outcome measures Numbers of patients; presentations; age; gender; postcode; reason for encounter; consultation length; availability of General Practitioner (GP); consultation activities and follow up; NP Medicare Benefits Scheme (MBS) item number rebate; and equivalent GP MBS item number rebates. Results Over 50% of patients were female; 60% aged over 45 years. Patients had 2.6 encounters with the NPCC; over 50% lasting between 10 and 20 minutes. Approximately half the revenue of that claimed in equivalent GP encounters. Common reasons for attendance were symptoms and complaints (37.2%) and attendance was viewed as convenient and accessible, despite having a regular GP (47.8%). Fifty six Patients responded to a satisfaction survey and indicated they were satisfied with the service would use the service again and would recommend it. Conclusions The NPCC provided an accessible service that met patients’ needs in a rural community. The study provides evidence that NPs can provide medical management in areas where medical service delivery gaps exist. However, there was a significant discrepancy between funding reimbursements for services provided at the NPCC and those provided by GPs. Acknowledgements We thank all health consumers who attended the NPCC inspiring our vision during its tenancy. This paper was funded by the aid of the Victorian Nurse Practitioner Publication Grant, Nursing and Midwifery Policy, Department of Health. Approval to undertake the study was obtained from Monash University Research Ethics Committee.