The Impact of Funding Models on the Integration of Registered Nurses in Primary Health Care Teams

Primary health reform in Canada have introduced various funding models designed to promote inter-professional teams. Despite the recognition that appropriate funding models are critical to support collaborative primary health care teams, few studies have described these funding models in relation to the roles and functions of non-physician health care providers. Family practice nurses are Registered Nurses (RNs) who practice in primary health care. Little is known about the impact of funding models on integration of family practice nurses in primary health care. The project consists of three studies: the funding model analysis, the case studies and the survey of family practice nurses. In the Funding Model Analysis, we will identify and classify funding models used to include family practice nurses in primary health care settings across Canada. In the Case Studies, we will conduct qualitative interviews with family practice nurses, family physicians and administrators; and administer a nurse activity survey in 32 practices funded by four funding models in Ontario, Quebec, and Nova Scotia: traditional fee-for-service, enhanced fee for service, capitation, and global funding. We will then conduct a cross-sectional, online survey of the 2000 family practice nurses in Canada to gather information about funding models, nurse work activities, and team functioning. Using the different methods of the Case Studies and the Family Practice Nurses Survey, we will study how the four funding models influence the activities performed by family practice nurses, the training and skills sets needed by family practice nurses, how the team functions, and the co-management of patient care. The research findings will help provincial governments in structuring funding models that best optimize the roles of family practice nurses and realize benefits from team-based care, and ultimately improve primary health care in Canada.